Job Description

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

Knowledge/Skills/Abilities

• Works closely with the WA healthcare Authority and the State actuaries on rate advocacy
• Develops VBC models and Risk Adjustment Tools
• Construct analytical models and provide metric-driven recommendations for financial savings initiatives
• Creates new databases and reporting tools for monitoring, tracking, and trending based on project specifications.
• Develops, implements, and uses software and systems to support the department's goals.
• Develops and generates ad-hoc and standard reports using SQL programming, SQL Server Reporting Services (SSRS)
• Develops VBC models and Risk Adjustment Tools
• Provides peer review of critical reports and guidance on programming / logic improvements
• Provides guidance to team members in their analysis of data sets and trends using statistical tools and techniques to determine significance and relevance.
• Participate in and guide the design of large scale predictive and statistical models to predict future trends in cost, utilization, and performance.
• Applies process improvements for the team's methods of collecting and documenting report / programming requirements from requestors to ensure appropriate creation of reports and analyses while reducing rework.

Job Qualifications

Required Education

• Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems or related field

Required Experience

• 5 years experience leading healthcare analytics function

• 12 years work experience preferable in claims processing environment and/or healthcare environment

• Strong knowledge of SQL 2005/2008 SSRS 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

5 – 7 years supervisory experience

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.