Manager, Medical Economics (New York Health Plan)

Manager, Medical Economics

The Manager, Medical Economics provides support and consultation to the New York 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.

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.

Extracts and compiles information from various systems to support executive decision-making. Mines and manages information from large data sources. Analyzes claims and other data sources to identify early signs of trends or other issues related to medical care costs. Works 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. Works with business owners to track key performance indicators of medical interventions. Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives. Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of the suspect / problem areas, and suggests a corrective action plan. Draws actionable conclusions based on analyses performed, makes recommendations through use of healthcare analytics, predictive modeling, and communicates those conclusions effectively to audiences at various levels of the enterprise. Analyzes the financial performance of all Molina Healthcare products, identifies favorable and unfavorable trends, develops recommendations to improve trends, and communicates recommendations to management. Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports. Serves as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes. Provides data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making. Supports Financial Analysis projects related to medical cost reduction initiatives and budgeting same. Supports Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results. Keeps 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

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

35 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. Pay Range : $88,453 - $206,981 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.