Manager, Medical Economics - REMOTE

JOB DESCRIPTION

Job Summary

Manages team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Collaborates with health plans to identify and track savings opportunities. Coordinates and leads trend review meetings related to clinical programs and initiatives for the Medicaid line of business.

Essential Job Duties

• Provides oversight for the medical economics team and activities, ensuring delivery of work/project plans and required reporting.
• Recruits, hires, onboards, mentors, develops, and manages medical economics staff.
• Provides daily management of data management, tools and technology work streams.
• Facilitates workload distribution of new reports and project requests.
• Acts as a resource to the team for medical economics/analysis related questions.
• Reviews medical economics analysis work products to ensure accuracy and clarity.
• Reviews regulatory reporting requirements and health plan project documentation.
• Maintains reporting service level benchmarks for the enterprise information management (EIM) team.
• Represents the medical economics department in cross-departmental and operational meetings.
• Serves as liaison between EIM and medical economics for reporting needs.
• Manages the delivery and presentation of monthly trend and performance review presentations.
• Interfaces and maintains positive interactions with Medicaid leadership and medical economics personnel.

Required Qualifications

• At least 7 years of healthcare analytics and/or medical economics experience, preferably in a claims processing environment, or equivalent combination of education and experience.
• At least 1 year of management/leadership experience.
• Bachelor’s degree in statistics, mathematics, economics, computer science, healthcare management, or related field.
• Demonstrated understanding of Medicaid and Medicare programs or other health care plans.
• Analytical work experience within the healthcare industry (hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.).
• Strong knowledge of SSRS 2005/2008 and Power BI report development.
• Familiar with relational database concepts and SDLC concepts.
• Proficiency with retrieving specified information from data sources.
• Experience building dashboards in Excel, Power BI, and/or Tableau and data management.
• Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.).
• Knowledge of healthcare financial terms (e.g., PMPM, revenue) and standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) used in medical coding/billing (UB04/1500 form).
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, fee-for-service, Diagnosis Related Groups, Ambulatory Patient Groups, Ambulatory Payment Classifications, and other payment mechanisms.
• Understanding of value-based risk arrangements.
• Experience quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare.
• Ability to mine and manage information from large data sources.
• Demonstrated problem-solving skills.
• Strong critical-thinking and attention to detail.
• Ability to effectively collaborate with technical and non-technical stakeholders.
• Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Strong verbal and written communication skills.
• Proficient in Microsoft Office suite products, with key skills in Excel (VLOOKUPs and pivot tables)/applicable software proficiency.

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

Pay Range: $79,607.91 - $172,483.80 annual.
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.