Senior Long-Term Care – Rate Setting Analyst

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

📋 Description

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

• Employ sophisticated analytical methods and extensive datasets to assess costs, trends, and reimbursement outcomes.

• Evaluate how modifications in rates, policy updates, and cost drivers impact Managed Care Organizations (MCOs).

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

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

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

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

• Track changes in State and Federal policies, particularly concerning Wisconsin Medicaid, and evaluate their operational and financial implications.

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

• Draft 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 in data analysis, with an understanding of how rate-setting decisions influence Managed Care Organizations (MCOs).

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

• Familiarity with the Long-Term Care (LTC) ecosystem, including program structures and reimbursement frameworks.

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

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

• Excellent communication skills to convey complex analytical findings into clear, actionable insights.

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

• Bachelor's degree in Public Administration, Public Policy, Economics, Statistical Analysis, Healthcare Administration, Finance, or a related discipline.

• Experience in evaluating government, business, or healthcare policies that affect both internal and external stakeholders.

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

• Proficient in analyzing large datasets and creating quantitative or statistical models.

• Ability to compose and present comprehensive reports, analyses, and policy summaries.

• Strong problem-solving abilities and a history of recommending enhancements to business or technical processes.

• Experience with SQL or data warehousing tools.

• Knowledge of State/Federal regulations impacting 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 supporting Managed Care Organizations (MCOs), including an understanding of managed care financing and oversight.

• Understanding of Medicaid policy, healthcare reimbursement methodologies, actuarial concepts, and capitation rate development.

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

• Must participate in screenings, interviews, and meetings from a quiet location with a reliable internet connection.

• Video camera usage is required during interviews and the first week of orientation.

• A photo is required during screening for verification throughout the recruitment process.

🏝️ Benefits

• Flexible working arrangements.

• Opportunities for learning and career advancement.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational support.

• Leadership and technical development academies.

• Base pay may vary depending on geographic location, internal equity, job-related knowledge, skills, and experience.