Manager, Medical Economics - REMOTE

JOB DESCRIPTION

Job Summary
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.

Essential Job Duties

• Data Curation & Stewardship: 
-    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
• Authorization Data Enhancement
-    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
• Team Leadership & Execution 
-    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
• Cross-Functional Partnership
-    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
• Governance & Operationalization
-    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.

Required Qualifications

• 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.

Preferred Experience

• 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

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $79,607.91 - $172,483.8 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.