Senior Long-Term Care – Rate Setting Analyst

🔥 12 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• 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 the 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 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

🎯 Requirements

• 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 impact Managed Care Organizations (MCOs) • Experience interpreting public policy, preferably within 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 R, SAS, STATA, or SPSS • Strong statistical analysis, quantitative modeling, and data interpretation skills • 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 • Experience evaluating government, business, or healthcare policies that affect internal and external partners • Experience 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 track record of recommending improvements to business or technical processes • Experience with SQL or data warehouse tools • Familiarity with State/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 an understanding of managed care financing and oversight • Knowledge of Medicaid policy, healthcare reimbursement methodologies, actuarial concepts, and capitation rate development • Experience evaluating the financial and operational impacts of capitation rates, rate adjustments, and value-based payment arrangements • Must join screenings, interviews, and meetings from a quiet location with a stable internet connection • Video camera required during interviews and the initial week of orientation • Photo required during screening for verification throughout recruitment

🏖️ Benefits

• Work flexibility • Learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Base pay may vary based on geographic region, internal equity, job-related knowledge, skills, and experience