Medical Economics Sr. Analyst (Full-Time Remote, North Carolina Based)

The Medical Economics Sr. Analyst performs detailed statistical analysis related to the organization’s service delivery. The Sr. Analyst will create and manage reports that monitor care utilization, premium, and MLR. They will support the Director of Medical Economics in identifying potential cost of care initiatives. The Sr. Analyst will also act as the lead on liaising with business stakeholders to execute these initiatives and evaluate their efficacy.

This position is fulltime remote. While there is no expectation to be in the office routinely, the selected candidate should reside in North Carolina and be available to attend onsite in-person meetings when required. 

Responsibilities & Duties

Care Utilization Analysis

• Act as team lead for analysis and monitoring of care utilization through the lens of Medical Economics Metrics. These include, but are not limited to: PMPM, Utilization per thousand, prevalence and intensity
• Develop and maintain reports related to Care Utilization, Premium and Pay for Performance plans
• Monitor monthly utilization patterns and create utilization forecasts
• Identify cost drivers and work with the Director of Medical Economics to develop action plans
• Work with the business to identify opportunities for ad hoc reporting related to Care Utilization. Identify and liaise with key stakeholders to define reporting requirements

Financial Forecasting

• Create and maintain financial models to assess the impact of Medical Cost Action Plans
• Assess the financial impact of rate and policy changes made by the State of North Carolina to the Medicaid Tailored Plans
• Collaborate with Utilization Management to perform cost impact analyses when new services are introduced, and when service definitions for existing services are modified or changed

Reporting and Data Visualization

• Utilize SQL, Excel and MicroStrategy to develop and maintain dashboards, reports, and other data visualizations for various business stakeholders
• Prepare reports for business stakeholders using data visualization best practices. Present analytical insights to the business in a succinct, easily-understood format that facilitates operational decision-making

Research and Collaboration

• Stay up to date on industry trends, regulations and healthcare policies that may impact Alliance’s financial performance
• Collaborate with cross-functional teams, including Utilization Management and Provider Network, to develop data-driven recommendations and actionable strategies

Minimum Requirements

Education & Experience

Bachelor’s Degree in Healthcare Management, Health Informatics, Economics, Statistics, Finance, or a related field and at least five …