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Job Description

Job Summary

Perform data and error analysis to improve models, and clean and validate data for uniformity and accuracy. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. Execute data science and statistical analytical experiments methodically to help solve various problems and make a true impact across various healthcare domains.

Knowledge/Skills/Abilities

+ Directs Health Plan strategic analysis and planning coordinating across business units to meet data analysis.

+ Mentors, coaches, and provides guidance to direct reports.

+ Identifies and sets departmental priorities in alignment with the operating plan, budget, and regulatory requirements. Perform deep dive analyses across health plans, provide actionable analytical insights and collaborate with Health plans and cross-functional teams to optimize revenue outcomes to meet enterprise wide goals.

+ Observe Medicaid/Medicare/Marketplace growth opportunity and new policy rules that are developed for appropriate care for members and payments related to providers, initiate and develop analytical framework to support business cases, and present to business partners and management in remediating any process gaps.

+ Partner closely with all health plans to design Payment Integrity campaigns, evaluate performances, develop insights, and make actional recommendations to optimize future campaigns

+ Present complex analytical information to all level of audiences in a clear and concise manner Collaborate with analytics team, assigning and managing delivery of analytical projects as appropriate

+ Perform other duties as business requirements change, looking out for data solutions and technology enabled solution opportunities and make referrals to the appropriate team members in building out payment integrity solutions.

+ Apply statistical and computational methodologies to provide actionable insights and identify opportunities that optimize quality, consumer experience, and healthcare costs

+ Develop scalable, efficient, and automated processes for large scale data analyses and model development, validation, and implementation

+ Devise and utilize algorithms and models to mine big data stores, perform data and error analysis to improve models, and clean and validate data for uniformity and accuracy

+ Develop novel approaches for exploration, analysis and feature selection from large-scale multidimensional data

+ Execute data science and statistical analytical experiments methodically to help solve various problems and make a true impact across various healthcare domains

+ Analyze data for trends and patterns utilizing large data sets and Interpret data with a clear objective in mind

+ Use a broad range of tools and techniques to extract insights from current industry or sector trends

+ Utilize and implement tools and languages such as Hadoop, Power BI, R, Python, SQL, Impala SQL, Toad Automation scripts, Apache Superset, Python Healthcare and Data science packages.

+ Implementation of python packages building Patient focused population predictions, provider specific – activity (prescriptions / procedures) outliers.

Job Qualifications

REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:

Bachelor's Degree in Data Science, Economics, Finance, Computer Science, Information System/Technology, or related field.

REQU** **I** **RED EXPERICENCE:

+ 5 years’ experience leading healthcare analytics function

+ 7 years’ work experience preferable in healthcare environment

+ Strong knowledge of Hadoop, Power BI, R, Python, SQL, Impala SQL, Toad Automation scripts, Apache Superset, Python Healthcare and Data science package

+ Familiar with relational database concepts, and SDLC concepts

+ Demonstrate critical thinking and the ability to bring order to unstructured problems.

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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: $129,504 - $303,040 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.