Senior Long -Term Care - Rate Setting Analyst

Gainwell Technologies LLC•Any city, OH

8d•Remote

About The Position

As a Senior Long-Term Care - Rate Setting Analyst at Gainwell, you will take a lead role in developing and maintaining rate-setting methodologies that support a large, complex Medicaid long-term care program. You will apply deep data expertise, interpret policy impacts — particularly within Wisconsin Medicaid — and understand how rate decisions affect Managed Care Organizations (MCOs) and the broader long-term care ecosystem. Bring your analytical strengths and passion for public service to a team committed to improving program transparency, efficiency, and outcomes for the communities we serve.

Requirements

6+ years of experience in business analysis, financial modeling, health policy analysis, Medicaid policy analysis, public administration, or public sector program evaluation
Strong data expertise, including understanding how rate-setting decisions impact Managed Care Organizations (MCOs)
Experience interpreting public policy, preferably within healthcare and/or Wisconsin Medicaid
Understanding of the Long-Term Care (LTC) ecosystem, including program structures and reimbursement models
Advanced skills in Excel and/or analytical tools such as R, SAS, STATA, or SPSS
Strong statistical analysis, quantitative modeling, and data interpretation skills, with the ability to translate complex findings into actionable recommendations
Strong communication skills to translate complex analytical work into clear, actionable insights
Ability to work independently, manage timelines, and support multiple projects at once
Bachelor's degree in Public Administration, Public Policy, Economics, Statistical Analysis, Healthcare Administration, Finance, or a related field

Nice To Haves

Master's degree preferred
Experience evaluating government, business, or healthcare policies that affect internal and external partners
Experience working with Medicaid programs, rate-setting methodologies, or capitated payment models
Experience analyzing large datasets and developing quantitative or statistical models
Ability to write and present comprehensive reports, analyses, and policy summaries
Strong problem-solving skills and a track record of recommending improvements to business or technical processes
Experience with SQL or data warehouse tools
Education or training in public policy, economics, statistics, or a related field
Familiarity with State/Federal regulations influencing long-term care and Medicaid operations
Professional experience working within a state Medicaid agency, state policy office, healthcare policy organization, or government-funded healthcare program
Experience working for or directly supporting Managed Care Organizations (MCOs), including an understanding of managed care financing and oversight
Knowledge of Medicaid policy, healthcare reimbursement methodologies, actuarial concepts, and capitation rate development
Experience evaluating the financial and operational impacts of capitation rates, rate adjustments, and value-based payment arrangements

Responsibilities

Play a critical part in ensuring rate-setting and reimbursement strategies meet program, policy, and organizational goals.
Lead the development, enhancement, and documentation of rate-setting models for long-term care programs
Use advanced analytical techniques and large datasets to evaluate costs, trends, and reimbursement outcomes
Assess how rate changes, policy updates, and cost drivers affect Managed Care Organizations (MCOs)
Translate business needs into clear data, system, and policy requirements
Research reimbursement methodologies, program operations, and the long-term care ecosystem to recommend improvements
Support the development and implementation of capitated rate-setting methodologies for contracted MCOs
Validate the accuracy and sufficiency of rates produced by established models
Monitor State and Federal policy changes — with emphasis on Wisconsin Medicaid — and assess their operational and financial impact
Partner with internal teams, business leaders, and external stakeholders to promote transparency and alignment in rate-setting practices
Prepare written analyses, presentations, and recommendations for leadership, clients, and technical teams