Senior Long-Term Care – Rate Setting Analyst

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Oversee the creation, enhancement, and documentation of models used for rate-setting in long-term care programs.

• Employ advanced analytical methods and extensive datasets to assess costs, trends, and reimbursement results.

• Evaluate the impact of rate modifications, policy changes, and cost drivers on Managed Care Organizations (MCOs).

• Convert business requirements into precise data, system, and policy specifications.

• Investigate reimbursement methods, program operations, and the long-term care environment to suggest enhancements.

• Assist in the development and execution of capitated rate-setting methods for contracted MCOs.

• Confirm the accuracy and adequacy of rates generated by established models.

• Track State and Federal policy modifications, particularly regarding Wisconsin Medicaid, and evaluate their operational and financial implications.

• Collaborate with internal teams, business leaders, and external partners to foster transparency and coherence in rate-setting practices.

• Create written analyses, presentations, and recommendations for leadership, clients, and technical teams.

⛳️ Requirements

• A minimum of 6 years of experience in business analysis, financial modeling, health policy analysis, Medicaid policy analysis, public administration, or public sector program evaluation.

• Proficient data skills, particularly in understanding the effects of rate-setting decisions on Managed Care Organizations (MCOs).

• Experience in interpreting public policy, ideally within the healthcare sector and/or Wisconsin Medicaid.

• Knowledge of the Long-Term Care (LTC) ecosystem, including program frameworks and reimbursement models.

• Advanced proficiency in Excel and/or R, SAS, STATA, or SPSS.

• Strong capabilities in statistical analysis, quantitative modeling, and data interpretation.

• Excellent communication abilities to convert complex analytical findings into clear, actionable insights.

• Ability to work autonomously, manage timelines, and juggle multiple projects simultaneously.

• A bachelor's degree in Public Administration, Public Policy, Economics, Statistical Analysis, Healthcare Administration, Finance, or a related field; a master's degree is preferred.

• Experience in evaluating government, business, or healthcare policies.

• Familiarity with Medicaid programs, rate-setting methodologies, or capitated payment models.

• Experience in analyzing large datasets and developing quantitative or statistical models.

• Ability to produce and present detailed reports, analyses, and policy summaries.

• Strong problem-solving abilities.

• Experience with SQL or data warehouse tools.

• Educational background or training in public policy, economics, statistics, or a related field.

• Understanding of State/Federal regulations affecting long-term care and Medicaid operations.

• Professional experience in a state Medicaid agency, state policy office, healthcare policy organization, or government-funded healthcare program.

• Experience working for or directly assisting Managed Care Organizations (MCOs), including knowledge of managed care financing and oversight.

• Familiarity with Medicaid policy, healthcare reimbursement methodologies, actuarial concepts, and capitation rate formulation.

• Experience in assessing the financial and operational consequences of capitation rates, rate adjustments, and value-based payment arrangements.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.