Sr Managed Care Financial Analyst

LSMA Management Inc • Redlands, CA

1d • Hybrid

About The Position

The Senior Managed Care Financial Analyst leads the financial oversight and performance reporting of delegated risk and value-based care arrangements for LaSalle Medical Associates and LaSalle Health Plan. Reporting to the Director of Healthcare Analytics, the Senior Managed Care Financial Analyst is accountable for the accuracy and timeliness of the full financial lifecycle of delegated risk arrangements, including capitation, medical cost, shared savings/losses, quality bonuses, risk pools, risk corridors, and stop-loss. The Senior Managed Care Financial Analyst is responsible for ensuring alignment with delegated agreements, capitation arrangements, and regulatory, contractual, and organizational requirements. This position collaborates closely with other departments and senior leadership to optimize financial outcomes across capitation, shared savings, and fee-for-service models. The Senior Managed Care Financial Analyst is essential to the successful operation of a Management Services Organization (“MSO”), serving as the financial steward of the organization’s delegated risk and value-based care arrangements. MSOs operate in complex reimbursement environments—capitation, shared savings, risk adjustment, and quality incentives—where even small inaccuracies in data, payments, or assumptions can have significant financial consequences. This role ensures the organization maintains financial stability, meets regulatory obligations, and operates effectively under these reimbursement models.

Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Finance, or related field.
• 5 years of progressive experience in healthcare finance, managed care analytics, or reimbursement within an MSO, Independent Physician Association (“IPA”), health plan, Accountable Care Organization (“ACO”), or large medical group.
• Hands-on experience with capitation, medical expense analysis, risk adjustment (RAF/HCC), and value-based payment structures.
• Experience working with claims, encounter data, capitation files, eligibility files, and payer reporting.
• Background in financial modeling, budgeting, forecasting, and variance analysis.
• Deep understanding of managed care financial models, including capitation, PMPM revenue, shared savings, risk sharing, IBNR, risk adjustment, medical utilization and medical loss ratio (MLR) dynamics.
• Working knowledge of healthcare claims and encounter data, eligibility files, risk score methodologies (RAF/HCC), and reimbursement structures across Medicare Advantage, Commercial HMO, and Medicaid managed care.
• Familiarity with delegated-risk requirements, health plan reporting standards, and compliance expectations set by the Centers for Medicare & Medicaid Services (“CMS”, Department of Managed Health Care (“DMHC”), and other regulatory bodies.
• Broad understanding of operational functions influencing managed care performance (e.g., utilization management, contracting, provider relations, revenue cycle, and claims operations).
• Ability to analyze large datasets, identify cost drivers, and translate complex financial trends into clear, actionable insights.
• Proficiency in financial planning tools and processes, including budgeting, forecasting, modeling, and variance analysis for capitation and medical expenses.
• Strong Excel skills and experience with analytics/reporting tools such as Power BI, Tableau, and SQL.
• Excellent leadership and people management skills, with the ability to motivate and develop staff in a high-accuracy, high-accountability environment.
• Exceptional communication skills, both written and verbal, with the ability to interact effectively with internal teams, external partners, and leadership, with a high regard for attention to detail.
• Ability to manage multiple priorities, meet deadlines, and work in a fast-paced, compliance-driven environment.
• Ability to maintain confidentiality and adhere to HIPAA regulations.
• Prolonged periods of sitting, frequent use of a computer, telephone, and video conferencing platforms, and sustained visual focus when reviewing eligibility records, enrollment data, reports, policies, and contracts.
• Significant mental concentration, analytical thinking, and attention to detail when interpreting benefits, eligibility rules, capitation-related data, and regulatory requirements.
• Ability to lift, carry, push, or pull items up to approximately 20 pounds (e.g., laptop, files, binders, or work materials).
• Adequate visual and auditory acuity to review written and electronic materials, analyze data and reports, and communicate effectively with staff, leadership, health plan representatives, and other internal and external stakeholders.
• Periods of high workload, time-sensitive deadlines, and exposure to confidential or complex information requiring discretion, professionalism, and sound judgment.

Nice To Haves

• 7+ years of managed care experience in delegated-risk environments (Medicare Advantage, Medicaid managed care, and Commercial Health Maintenance Organization (“HMO”).
• Experience leading or mentoring analysts or finance teams.
• Advanced expertise in financial modeling, capitation structures, and medical cost performance management.
• Demonstrated success leading cross-functional teams in MSO or risk-bearing settings.
• Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration for this position.

Responsibilities

• Leads the financial oversight and performance reporting of delegated risk and value-based care arrangements.
• Accountable for the accuracy and timeliness of the full financial lifecycle of delegated risk arrangements, including capitation, medical cost, shared savings/losses, quality bonuses, risk pools, risk corridors, and stop-loss.
• Ensures alignment with delegated agreements, capitation arrangements, and regulatory, contractual, and organizational requirements.
• Collaborates with other departments and senior leadership to optimize financial outcomes across capitation, shared savings, and fee-for-service models.
• Serves as the financial steward of the organization’s delegated risk and value-based care arrangements.
• Ensures the organization maintains financial stability, meets regulatory obligations, and operates effectively under complex reimbursement models.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior