Senior Predictive Analytics Leader for Risk Management

Job Description Job Summary Join Molina's dynamic team as a Senior Predictive Analytics Leader for Risk Management. In this pivotal role, you will spearhead our Risk Adjustment Predictive Analytics initiatives, enhancing both our Prospective and Retrospective Interventions. Your expertise will be instrumental in designing systems that drive quality outcomes while empowering team members through essential training. Knowledge/Skills/Abilities Support the Risk Adjustment Data Analytics team in analyzing and optimizing our Intervention strategies, while effectively monitoring their progress and success. Develop and implement both ad-hoc and automated analytics related to Risk Adjustment across Medicaid, Marketplace, and Medicare/MMP. Collaborate to create an Automated Suspect and Target/Ranking Engine that serves all business lines. Conduct comprehensive analyses of Managed Care data, including medical claims, pharmacy, lab, and financial metrics such as risk scores and revenue. Perform root cause analyses for data-related issues, summarizing actionable insights for leadership. Lead the design and implementation of systems for monitoring risk scores and their impacts across various markets. Work in an agile setting to extract valuable insights from complex, large data sets through meticulous analysis and data mining. Engage with stakeholders at all levels to clarify business needs and necessary data metrics. Analyze datasets for trends and anomalies, applying statistical techniques to forecast future cost and utilization trends, and present your findings succinctly to executives. Assist with special projects requested by internal departments or external regulatory bodies. Stay informed on CMS/State regulations affecting Risk Adjustment Analytics, providing training and guidance as required. Manage updates to the Datawarehouse platform, ensuring smooth transitions in analytics reporting systems. Conduct thorough analyses post-code changes to validate data analytics and reporting accuracy. Create enriching training modules to elevate analysts' expertise in business processes and solutions. Foster a team culture that thrives in agile environments, promoting a positive approach to challenging projects. Take ownership of assigned tasks and projects, driving them to successful completion. Job Qualifications Required Education Bachelor's Degree in Computer Science, Finance, Mathematics, Economics, or a closely related field. Required Experience 6+ years of experience in data mapping, scrubbing, and cleaning. 5+ years in a Managed Care Organization in a techno-functional role with advanced SQL query expertise. 5+ years of proficiency with Microsoft T-SQL, SSIS, and SSRS. Familiarity with Data Science methodologies and programming languages, such as Python and R, is advantageous. 5+ years analyzing Risk Scores, Encounter Submissions, and Payment Models for Medicaid, Marketplace, or Medicare/MMP. 5+ years of experience in analytics and reporting for Prospective, Retrospective, and Audit targeting. 5+ years managing complex data issues, focusing on financial and performance metrics. 5+ years in statistical analysis and forecasting medical cost trends to support financial and actuarial functions. PHYSICAL DEMANDS The working environment is generally favorable, with adequate lighting and temperature. Work is typically performed in an office setting with minimal exposure to unpleasant conditions. The ability to sit for extended periods is required. Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions. To all current Molina employees: If you are interested in this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,412 - $188,164 / ANNUAL *Actual compensation may vary based on geographic location, work experience, education, and skill level.