Manager, Medical Economics - REMOTE

Molina Healthcare•Long Beach, CA

1d•Remote

About The Position

Responsible for leading the refinement, operationalization, and stewardship of enterprise healthcare datasets for Medical Economics use cases. This role focuses on transforming foundational enterprise data assets into trusted, business-ready datasets aligned to Medical Economics reporting, analytics, and operational workflows. The curation and enhancement of authorization data assets is an initial priority. This role partners closely with Enterprise Information Management (EIM), Medical Economics, Reporting, and operational stakeholders to improve data quality, establish sustainable governance practices, and support scalable enterprise data solutions.

Requirements

At least 7 years of health care analytics and/or medical economics experience, preferably in claims processing environment and/or health care environment, or equivalent combination of relevant education and experience.
At least 1 year of management/leadership experience.
Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field.
Demonstrated understanding of Medicaid and Medicare programs or other health care plans.
Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
Familiar with relational database concepts
Proficiency with retrieving specified information from data sources.
Experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
Knowledge of health care operations (utilization management, disease management, claims processing, etc.)
Knowledge of health care 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 health care.
Ability to mine and manage information from large data sources.
Demonstrated problem-solving skills.
Strong critical-thinking and attention to detail.
Ability to effectively collaborate with technical and non-technical stakeholders.
Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Strong verbal and written communication skills.

Nice To Haves

Experience in Medical Economics Business stakeholder management
Familiarity with Python, R or BI tools (e.g., Tableau, Power BI)
Experience with service categorization
Deep auth data knowledge

Responsibilities

Lead refinement and operationalization of enterprise datasets for Medical Economics use cases
Establish and maintain business definitions, transformation logic, validation rules, and reconciliation processes
Identify and resolve data quality, consistency, and usability gaps across curated datasets
Drive continuous improvement of data assets to support evolving business needs
Lead Medical Economics curation efforts for authorization data assets
Define and document business logic and operational interpretations required for Medical Economics workflows
Partner with EIM and upstream data owners to improve foundational data quality and alignment
Ensure curated authorization datasets are scalable, reliable, and analytically usable
Manage and mentor Lead Analysts supporting data curation initiatives
Establish standards for documentation, validation, issue management, and operational support
Support prioritization and delivery planning across the team
Serve as a liaison between Medical Economics, EIM, Finance, and operational stakeholders
Translate business pain points into actionable data improvement opportunities
Facilitate alignment on definitions, priorities, dependencies, and implementation sequencing
Support governance processes for curated datasets
Maintain documentation for business rules, lineage, assumptions, and operational workflows
Promote transparency, consistency, and sustainable support models across data assets
Coordinates with medical economics team to meet data analysis and database development needs.
Reviews, evaluates, and improves business logic and data sources.
Acts as a resource to team for medical economics/analysis related questions.
Reviews medical economics analysis work products to ensure accuracy and clarity.
Reviews regulatory reporting requirements and health plan project documentation.
Maintains reporting service level benchmarks for enterprise information management (EIM) team.
Represents medical economics department in cross-departmental and operational meetings.
Serves as liaison between EIM and medical economics for reporting needs.
Collects, validates, analyzes, and organizes data into meaningful reports for leadership decision making, and designs, develops, tests and deploys reports to other end users for operational and strategic analysis.
Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns and medical management.
Collaborates with and provides medical economics subject matter expertise for health plans and enterprise teams.
Supports scoreable action item (SAI) initiative tracking to performance.