Senior Long-Term Care - Rate Setting Analyst

Gainwell Technologies LLC•Madison, WI

7d•$69,400 - $99,200•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 for a large, complex Medicaid long-term care program. You will apply 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. The role supports rate-setting and reimbursement strategies that meet program, policy, and organizational goals, while advancing transparency, efficiency, and outcomes for the communities served. The position is fully remote from locations within the contiguous United States. Video cameras are required during interviews and the initial week of orientation. The application deadline is November 12, 2026.

Requirements

At least 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 affect Managed Care Organizations (MCOs).
Experience interpreting public policy, preferably in 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.
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 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 and 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 understanding managed care financing and oversight.
Knowledge of Medicaid policy, healthcare reimbursement methodologies, actuarial concepts, and capitation rate development.
Experience evaluating financial and operational impacts of capitation rates, rate adjustments, and value-based payment arrangements.

Responsibilities

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 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.