Risk Adjustment, Manager Healthcare Economics - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together .

As the Optum Care National Risk Adjustment Healthcare Economics Team, we support all risk adjustment efforts across our enterprise, primarily focused on Medicare Advantage Risk Modeling and Financial Forecasting. We are internal analytics partners who provide expertise to our finance, operations, accounting, and clinical leads to identify coding gaps, assess opportunity, forecast, and analyze risk. If you eat, breathe, and sleep risk adjustment like we do, then this is the right place for you! If you’re not a risk adjustment expert, but hungry, driven, and willing to learn, we will help you become one of the best-in-class experts in the field.

As a Manager Healthcare Economics, you will help lead key efforts around risk score forecasting, revenue assessment, predictive suspecting, program evaluations, and strategic guidance related to Medicare Advantage Risk Adjustment.

The role also requires knowledge of the CMS Medicare Advantage payment models, and expert knowledge of data access, construction, and manipulation of large datasets to support planned analyses, using advanced SQL development or similar tools.

You’ll enjoy the flexibility to work remotely

• from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities :

This is an individual contributor role responsible for leading a region and / or markets for forecasting revenue and collaborating with finance and accounting teams

Assist in leading complex analytic projects leveraging data from multiple sources

Understand and apply highly technical specifications to healthcare datasets

Serve as key healthcare economics and analytics contact for local, regional, and national OptumCare leadership and key national finance and operations stakeholders

Multitask, prioritize, adapt to change, work well under pressure in an entrepreneurial environment, meet deadlines, and manage a project from start to finish

Develop full understanding of CMS guidelines and specifications as it relates to Medicare Advantage and Risk Adjustment

Identify and implement appropriate analytic and forecasting methodologies

Develop and manage advanced forecast models

Design, produce and support development of dashboards and key performance indicator reports to meet customer requirements

Leverage and coordinate enterprise-wide capabilities to meet business-specific needs

Educate non-technical stakeholders on risk adjustment topics from the clinical, operational, and financial perspective

Communicate results to relevant audiences, and seek and apply feedback into future iterations and new analytic development

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :

Degree in Economics, Statistics, Finance, Health Administration, Mathematics or related field and 3+ years of advanced analytics experience focused on healthcare data

Knowledge of the CMS Risk Adjustment models and applicability as it relates to revenue cycle analytics and forecasting

Analytical expertise in data analysis, statistical analysis, data manipulation, data extraction, and reporting

Advanced proficiency with SQL development

Proficient with MS Excel, including creating Macros, Pivot Tables, SUMIFS, SUMPRODUCT, and VLOOKUPs, etc.

Preferred Qualifications :

Experience in supporting finance and accounting partners through an analytics focused role, including forecasting techniques

Experience in predictive modeling, data manipulation, reporting, and analysis

Experience synthesizing analysis into actionable and easy to digest insights

Experience measuring impact and ROI of operational programs and services

Experience with Snowflake

Advanced to expert proficiency with SAS and / or other data manipulation and statistical tools

Knowledge of CMS regulations and specifications regarding Medicare Advantage risk adjustment

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,800 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.