Medical Management Analyst

Medical Management Analyst

We are seeking a Medical Management Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role

The Medical Management Analyst plays an important role in supporting value-based care partners in efforts to improve membership growth, quality of care and service, member outcomes, and unnecessary utilization of health care resources. The Medical Management Analyst will produce the reports needed to evaluate, monitor, and optimize provider performance, and provide insights into root-cause issues and opportunities for improvement. This role works in collaboration with Provider Relations, Medical Economics, Utilization Management and Quality Improvement to provide education on report generation, provide support in understanding report content, automate reporting, and optimize the quality of the reports. The end result of this role is to provide the data insights to improve provider engagement in the delivery of cost-effective, high-quality care and in creating excellent patient experience.

Minimum Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business, or a related field.
• A minimum of 2 years of experience in health care analytics, medical analysis, or a related role.
• Strong analytical thinking and a proactive approach to problem solving.
• Proficiency in data analysis tools and software such as Excel, PowerPoint, SQL, Power Query, Power Pivot.
• Proven experience automating recurring reports and familiarity with data visualization tools such as Power BI, Tableau.
• Experience in managed care industry with deep understanding of managed care statistics.
• Excellent communication and interpersonal capabilities to effectively collaborate with diverse teams.
• Relevant experience may substitute for educational requirement on a year-for-year basis.

Preferred Qualifications

• Master's degree in Healthcare Administration, Public Health, Business Administration, or a related discipline.
• Experience with electronic health records (EHR) systems and healthcare quality improvement methodologies.
• Certification such as Certified Professional in Healthcare Quality (CPHQ) or Certified Medical Manager (CMM).
• Familiarity with healthcare reimbursement models and insurance processes.

Responsibilities

• Analyze clinical and operational data to assess the effectiveness and efficiency of medical management programs.
• Develop and implement strategies to improve healthcare delivery, member outcomes, and cost management.
• Collaborate with healthcare providers, administrators, and internal stakeholders to identify process improvements and develop reports.
• Design and produce detailed report templates and presentations that communicate findings, recommendations, and progress to leadership and relevant teams.
• Provide training and support to stakeholders on report generation and content
• Monitor and evaluate partnership performance metrics to ensure alignment with organizational goals.