![Molina Healthcare](https://media.trabajo.org/img/noimg.jpg)
Sr. Analyst, Network Strategy
1 month ago
Job Description
Job Summary
Sr. Analyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality care with improved outcomes through better coordination and preventive care and develop payment strategies that give incentives to providers and healthcare systems that deliver better health, more affordably.
Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care models.
Knowledge/Skills/Abilities
•Develop key strategic reports and analysis using SQL programming, SQL Server Analytic Services (SSAS), Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard.
•Generate hospital performance analytics tools on a quarterly basis; develop reports on a regular basis using SQL, Excel, and other reporting software.
•Research, develop, analyze and recommend cost savings opportunities in alignment to support enterprise strategies
•Track, monitor, and report cost savings initiatives (hospitals, physicians, ancillary) trend analyses, and its performance on a monthly basis.
•Conduct financial modeling and analysis (including trend analysis) by utilizing NetworX Modeler and ETL systems to support negotiating strategies, modeling current and future contract rate proposals.
•Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of reimbursement changes, educate/consult the health plans on the financial impact.
•Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting
•Ability to translate contract rates and terms to evaluate the financial impact to effectively negotiate new or amended contracts (e.g. coding and chargemaster impact analysis)
•Strong written and verbal communication skills required to present analytical results and findings to healthplans' senior management team and key stakeholder meetings (PowerPoint)
•Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ensure timely deliverables to stakeholders requiring decision support.
•Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.
•Provides peer review of pricing configuration to ensure accuracy of financial modeling
•Provides peer review of team members' presentations for total cost of care and profit improvement initiatives
•Support process improvements for the team's methods of collecting and documenting report / programming requirements
•Serves as a key resource on the more complex pricing and analysis issues
•Reviews work performed by others and provides recommendations for improvement.
Job Qualifications
Required Education
•Bachelor's degree in Business, Finance, Mathematics, Economics, Data Science or Actuarial Sciences or equivalent experience
Required Experience
•5+ years of analytics experience in financial analysis, healthcare pricing, network management,
healthcare economics or related discipline.
•5+ years increasingly complex database and data management responsibilities
•Advanced level proficiency in Microsoft Excel
•Intermediate to advanced level proficiency in SQL
•5+ years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics
Preferred Education
Master's degree
Preferred Experience
•Preferred experience in healthcare medical economics and/or strong financial analytics background
•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
•Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
•Experience with industry standard normalization/reimbursement methodologies (APR-DRG, MS-DRG, EAPG, APC)
- Value based purchasing experience; modeling and reconciliations.
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.
-
Sr. Analyst, Network Strategy
2 months ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJob Description Job SummarySr. Analyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality care with improved outcomes through better coordination and...
-
Sr Network Data Analyst
2 weeks ago
Mastic Beach, United States MyCareersFuture Full timeRoles & Responsibilities Sr Network Data Analyst - Network Capacity Planning Based in Singapore, the regional hub for Asia Pacific (AP) and top-ranked biopharmaceutical company on The Straits Times and Statistas list of Best Employers in Singapore for two consecutive years (2020, 2021). Join the premier biopharmaceutical company that has been in...
-
Direct to Consumer Strategy Sr. Analyst
1 month ago
Long Island City, United States Bloomingdale's Full timeAbout:Bloomingdale's makes fashion personal and fun, aspirational yet approachable. Our mission is to guide and inspire our customers to make style a source of creative energy in their lives. We will always strive to make Bloomingdale's like no other store in the world. Everyone plays a critical role to bring our mission to life. Regardless of position, we...
-
Direct to Consumer Strategy Sr. Analyst
1 month ago
Long Island City, United States Bloomingdale's Full timeAbout:Bloomingdale's makes fashion personal and fun, aspirational yet approachable. Our mission is to guide and inspire our customers to make style a source of creative energy in their lives. We will always strive to make Bloomingdale's like no other store in the world. Everyone plays a critical role to bring our mission to life. Regardless of position, we...
-
IT Programmer Analyst, Sr
1 month ago
Juno Beach, United States Mindlance Full timePR:$51.95/hr Responsible for the development and integration of new or existing applications into the technical infrastructure and existing business processes. Provides technical or functional guidance to project or work teams as needed within a specific discipline. Collaborates on an on-going basis with the Business Systems Analyst. Analyzes, designs,...
-
Sr Analyst, Healthcare Analytics
1 month ago
Long Beach, California, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob SummaryThis Sr. Analyst, Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing risk score models with Databricks, organizing and managing large and varied data sets, analyzing healthcare data for decision support, and communicating findings. Qualified...
-
Sr Information Security Analyst
1 month ago
West Palm Beach, Florida, United States Vets Hired Full timeAbout the job Sr Information Security Analyst (Remote)Basic administration and management of security operations solutions and programs, such as our database security program, PKI and SIEM managementCertification in at least one of the following: CompTIA Security+, SANS GSEC, ISC2 SSCP, CompTIA CySA+Intermediate knowledge of Information Security concepts,...
-
Sr Information Security Analyst
1 month ago
West Palm Beach, United States Vets Hired Full timeAbout the job Sr Information Security Analyst (Remote)Basic administration and management of security operations solutions and programs, such as our database security program, PKI and SIEM managementCertification in at least one of the following: CompTIA Security+, SANS GSEC, ISC2 SSCP, CompTIA CySA+Intermediate knowledge of Information Security concepts,...
-
SR Project Analyst- Healthcare | Newport Beach, Ca |
3 months ago
Newport Beach, United States eTeam Inc Full timeTitle: Sr.Project Analyst Location: Hospital Facility- Newport Beach, CA 92663 Shift: M-F 8 am-5 pm, 40 GWW Duration: 6 month(s) Pay:$55/hr to $65/hr based on exp. Remote is available - but must be within 1 hour drive of Newport Beach. Duties: The Sr. Project Analyst – Value Management is responsible for supporting the implementation of initiatives...
-
Sr. Data Analyst
4 weeks ago
Deerfield Beach, United States Soft source inc Full timeJob DescriptionJob DescriptionPosition Title Sr. Data AnalystJOB DESCRIPTIONMUST HAVES: Operation System MigrationsSomeone that can work on converting data from mainframe system to SalesforceData Classification Data profiling Qualifications and Education Requirements:Bachelor's degree or equivalent plus 7 years of related professional experience Degree...
-
Sr Analyst, Healthcare Analytics
4 weeks ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob SummaryThis Sr. Analyst, Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing risk score models with Databricks, organizing and managing large and varied data sets, analyzing healthcare data for decision support, and communicating findings. Qualified...
-
Sr. Business Analyst, Pharmacy
1 week ago
Long Beach, United States SCAN Full timeAbout SCAN SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, Nevada, Texas and New...
-
Sr. Vendor Risk Analyst
3 weeks ago
Deerfield Beach, United States JM Family Enterprises Full timeWe are seeking a Senior Vendor Risk Analyst to join the Compliance team within our Enterprise Risk Office. The Sr. Vendor Risk Analyst evaluates vendor performance using standard tools to assess, score, and rank vendors across various categories. This role ensures contractual compliance and fosters robust vendor relationships. The ideal candidate will...
-
Customer Strategy Analyst
4 weeks ago
Long Island City, United States Bloomingdale's Full timeABOUT:Bloomingdale's makes fashion personal and fun, aspirational yet approachable. Our mission is to guide and inspire our customers to make style a source of creative energy in their lives. We will always strive to make Bloomingdale's like no other store in the world. Everyone plays a critical role to bring our mission to life. Regardless of position, we...
-
Customer Strategy Analyst
3 weeks ago
Long Island City, United States Bloomingdale's Full timeJob DescriptionABOUT: Bloomingdale's makes fashion personal and fun, aspirational yet approachable. Our mission is to guide and inspire our customers to make style a source of creative energy in their lives. We will always strive to make Bloomingdale's like no other store in the world. Everyone plays a critical role to bring our mission to life. Regardless...
-
Junior Financial Analyst
4 weeks ago
Virginia Beach, United States augmentjobs Full timeJob DescriptionJob DescriptionPosition Overview: We are seeking a detail-oriented and motivated Junior Financial Analyst to join our Investment Strategy team. In this role, you will assist in the analysis and development of investment strategies that align with our clients' goals and the firm's objectives. You will work closely with senior analysts...
-
Sr Analyst, People Analytics
3 weeks ago
Juno Beach, United States NextEra Energy Resources Full timeSelect how often (in days) to receive an alert: Sr Analyst, People Analytics Date: Aug 13, 2024 Company: NextEra Energy Requisition ID: 81921 Florida Power & Light Company is America’s largest electric company, providing clean, affordable, and reliable electricity to more than 12 million people in Florida. We operate one of the cleanest power generation...
-
Project Analyst
3 days ago
Newport Beach, United States eTeam Inc Full timeAbout the RoleWe are seeking a highly skilled Project Analyst to join our team at eTeam Inc. as a Sr. Project Analyst - Healthcare. This is a challenging and rewarding role that requires strong analytical skills, business acumen, and excellent communication skills.Key ResponsibilitiesSupport Strategic InitiativesThe successful candidate will support the...
-
Senior Tax Strategy Analyst
4 days ago
Deerfield Beach, Florida, United States National Black MBA Association Full timeJob OverviewAs a key contributor to the tax strategy implementation, the Senior Tax Strategy Analyst plays a vital role in optimizing tax obligations. Utilizing extensive knowledge of tax legislation and industry best practices, this position focuses on identifying new opportunities while enhancing existing tax processes. The role also involves mentoring...
-
Taxation Strategy Manager
3 days ago
Long Beach, California, United States Jobot Full timeBecome a key player in a thriving accounting firm.Attractive compensation and benefits package.Flexible work arrangements: in-office, hybrid, or remote.Join a vibrant finance team dedicated to excellence.Position: Permanent Tax ManagerRole Overview:Deliver expert tax guidance aligned with client business goals.Assess and implement various tax strategies to...