Managed Care Analyst jobs in Lexington, KY

Job Description

JOB DESCRIPTION

Job Summary

Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.
• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
• Responsible for developing appropriate methodologies and preparation of weekly reports.
• Encourages cooperative interactions between cross functional teammates.
• Coordinates work of other business data analysts and provides training to subordinates/team members.
• Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.
• Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements
• Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.
• Proficient in writing and analyzing database queries, including SQL, with hands-on experience.
• Knowledgeable in APIs and web services, demonstrating the ability to integrate and utilize these technologies effectively.
• Familiar with IT release cycles and production deployment processes, including end-user validation and testing protocols.
• Experience with User Acceptance Testing (UAT) and familiarity with quality assurance (QA) processes to ensure product reliability and performance.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7 years of business analysis or systems experience,
• 6 years managed care experience.
• Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.
• Must have worked in US Healthcare government programs such as Medicare, Medicaid, the Affordable Care Act, or similar, with experience in one or more of these programs.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 7-9 years project manager experience
• Experience working with complex, often highly technical teams.
• Experience in a similar role, with a strong understanding of IT systems and processes.
• Proven experience as a Product Owner, with a focus on delivering digital channels.
• Familiarity with the Core Payor systems such as QNXT, Facets, Metavance, its various modules and backend datamodel
• Strong understanding of the US Healthcare domain and operational processes including but not limited to Enrollment, UM, Claims & Care Management.

Preferred License, Certification, Association

Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred

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.

Job Info

Job Identification: 2028544

Job Category: Cross-Enterprise Roles

Posting Date: 2024-10-31T15:02:16 00:00

Job Schedule: Full time