Managed Care Analyst

Primary Accountability

The Managed Care Analyst is responsible for using health plan data to validate, contrast, and track opportunities for revenue growth and compiling external and internal data reports to ensure compliance and efficiency.

Description of Primary Responsibilities

• Responsible for producing, validating, and interpreting data for health plan membership and capitation reports and developing internal status reports to meet organizational revenue goals.

• Defines data requirements and develops data collection and analysis tools for payer-specific identities.

• Performs data validation to ensure integrity of reporting.

• Identifies, investigates, and reports discrepancies in the data or workflows.

• Maintains a work plan for post-production reports and presentations.

• Produces monthly reports on payer revenue.

• Maintains Compliance Data Base for all Health Plans and special projects.

• Uses collected data to evaluate the profitability of payer relationships for all lines of business:

• Medicare and Medicare Advantage Five Star Performance.

• Medi-Cal Managed Care Health Plan Audit/Compliance and Incentives.

• Commercial Health Plans P4P and HEDIS Performance.

• Health plan contract modeling

• Analyze utilization data such as PCP visits, ER visits, hospital admissions, and bed days and identify opportunities to control utilization.

• Assists data analysis efforts of other FHCN staff and departments as needed.

• Responsible for assessing the effectiveness of internal workflow impact on health plan revenue streams and ensuring current organizational policies follow existing contract terms.

• Responsible for adhering to the Attendance and Absenteeism Policy, recognizing that regular attendance is considered an essential function of all FHCN positions. Absenteeism is not being at work or failing to attend a paid workshop, training, or event unless the absence is protected by law.

• Ability to present to and work at any FHCN location, both at the beginning of a shift or during a shift, based on business need.

• Other duties as assigned.

Description of Primary Attributes

General Development:

• Possesses basic organizational skills, typically to organize own work.
• Works independently and as part of a team.
• Job responsibilities require individual development of priorities for effective performance of duties, including re-prioritization in response to changes in circumstances.
• Can effectively select from both established alternatives and modify approaches in response to situations encountered.
• Duties require drawing conclusions using inference and logic, which may differ from the conclusions others could draw.
• Consider how work affects other employees outside the department or functional area.

Professional & Technical Knowledge:

Effective June 1, 2026, all individuals hired into the role must:

• Possesses proficiency in written and verbal communication, basic mathematics, computer applications, and technical systems frequently acquired through one of the following:

• Required completion of an Associate's Degree program with a recognized major and a minimum cumulative GPA of 2.5; or

• A combination of relevant experience and completion of a high school diploma with a minimum cumulative GPA of 2.5, or General Educational Development (GED) with a minimum overall score of 162.5, and healthcare-related knowledge frequently acquired through completion of a trade school, para-professional, or certificate type program.

• If an individual has completed a degree at a higher level than required by the role and had a stronger GPA in that program, they may provide proof of GPA from that degree in lieu of the high school diploma or associate's degree.

• Have a minimum of two years of relevant experience, including experience in healthcare, preferably in a managed care environment.

• Have a minimum of two years of experience in data analysis and/or financial modeling.

• Demonstrate strong analytical and problem-solving skills.

Technical Skills:

• Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs, and other elements.
• Ability to use Advanced Microsoft Excel to analyze data, including formulas, functions, lookup tables, and other standard spreadsheet elements.
• Ability to develop sophisticated presentations in Microsoft PowerPoint, including embedded objects, transitions, and other elements.

Licenses & Certifications: None required.

Communications Skills:

• Job duties require employees to effectively communicate their opinions and extrapolations of information they collect, synthesize/analyze.
• Exercises tact and diplomacy to resolve mild conflicts or disagreements.
• Compiles, analyzes and prepares information in an effective written form, including correspondence, reports, articles, or other documentation.
• Effectively conveys technical information to non-technical audiences.

Physical Demands: The physical demands here in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay Scale:

Min: $69,807.05

Max: $111,691.28