Manager, Medical Economics (Medicaid) - REMOTE

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.

Requirements

• 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

Benefits

• Competitive benefits and compensation package
• Equal Opportunity Employer (EOE) M/F/D/V