Manager, Medical Economics (Medicaid) - REMOTE

JOB DESCRIPTION

Job Summary

The Manager, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends.

Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.

KNOWLEDGE / SKILLS / ABILITIES

Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths.

Extract and compile information from various systems to support executive decision-making

Mine and manage information from large data sources.

Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs.

Work with clinical, provider network and other personnel to bring supplemental context / insight to data analyses, and design and perform studies related to the quantification of medical interventions.

Work with business owners to track key performance indicators of medical interventions

Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives

Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect / problem areas, and suggest a corrective action plan

Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise

Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management

Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports

Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes

Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making

Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same

Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results

Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field

Required Experience

3 years management or team leadership experience

10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)

Strong Knowledge of SQL and PowerBI report development

Familiar with relational database concepts, and SDLC concepts

Preferred Education

Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field.

Preferred Experience

3 – 5 years supervisory experience

Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans

Experience with Databricks

Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)

Proficiency with Excel and SQL for retrieving specified information from data sources.

Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)

Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding / billing (UB04 / 1500 form)

Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.

• Understanding of value-based risk arrangements

Experience in quantifying, measuring, and analyzing financial, operational, and / or utilization metrics in healthcare

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

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Pay Range : $88,453 - $172,484 / ANNUAL