Senior Managed Care Analyst, CRC CA Region - Remote in Orange at Prospect Medical Systems

Date Posted: 1/12/2021

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    1/12/2021
  • Job ID:
    17629

Job Description

Current Employees Click HERE

Current employees can apply directly through the Internal Careers Center online for Prospect Medical job openings in California. For a streamlined application process, all you need is your four-digit employee ID number and a digital copy of your résumé handy before you apply.



Senior Managed Care Analyst, CRC CA Region - Remote

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Senior Managed Care Analyst, CRC CA Region, will analyze and synthesize financial and operational data to inform and accelerate the understanding of complex financial terms/ramifications of new and renegotiated contracts, as well as other strategic decisions to those who may not fully understand (hospital CEOs, Medical Group leadership, etc.) and to model different contracting and other strategic prototypes which will position us for financial success for each potential agreement or service.  Additionally, they will need to be able to showcase the core financial benefits/challenges of our business decisions both in terms of financial modeling, comparative analysis and creation of standardized financial presentations.

The analysis results will be presented utilizing Power Point, Excel, Business Analytics (BI) Platforms to assist the organization in understanding the valuation based framework we are working within for the myriad of contracting models (FFS, Capitation, Per Diem, DRG, AP-DRG) and types of agreements (plan to hospital, hospital to hospital, risk sharing agreements, ancillary agreements, LOAs and transfer agreements) for multiple different clients (health plans, PPOs, TPAs, risk bearing hospitals/IDS, risk bearing IPAs/Medical Groups,) and downstream providers on our Division of Financial Responsibilities (DOFRs) such as SNF, HH, Pharmacology, recuperative care and transportation. 

The successful candidate must be well organized, self-directed, attention to detail driven, be forward thinking, have excellent communication skills, be calm under pressure, open to challenge, suggestions and be able to successfully work with different communication styles and understand different points of view.  They must have the courage to differ with other points of view and to accept constructive feedback.  The successful candidate must be proficient in Business Applications such as: Excel, Power Point, Business Analytics (BI), and other analytic tools.  Ideally, they will have earned a bachelors in finance, accounting or business, have hospital financial analysis experience (prefer in a risk environment such as CA), be Microsoft Certified in Dynamics 365 Customer Service Functional (or the predecessor certification) services which is a customer service based solution to drive actionable insights to make business decisions. 



Job Responsibilities/Duties

  • An analyst is needed to in CT to prepare models in a timely fashion and perform the necessary analytics, so that negotiators do not have to perform their own analysis, reducing the risk of errors and making market assumptions that may not be accurate. 
  • Prepare models for physician, Value Based/Alternative Payment Methodology discussions, and ancillary / home health contract negotiations.
  • Prepare competitor analyses.
  • Model impact of payer policy changes to ensure material changes do not occur.
  • Preparing BATNA analyses on all sensitive negotiations.
  • Gather and analyze market data for all large payer negotiations using CHIME, Truven or other state-available data.
  • Prepare budget forecasts.
  • Maintain contract rate library.


Qualifications

Minimum Education: Bachelor’s degree in a finance, or commensurate experience and education (e.g. AA degree in finance and 5 years of hospital financial analytics experience) required.

Minimum Experience: A minimum of three (3) years of hospital finance and/or contracting experience for multi-hospital system or integrated delivery system required. Experienced and comfortable with development, use and challenge of reimbursement analysis and modeling. Excellent written, verbal communication and computer skills. Knowledge of the payor industry and comfortable presenting to senior leadership as well as communicating with Payors. Exceptional skills using Microsoft Office Excel (including advanced spreadsheet, formula manipulation and modeling) required.  Strong MS Word and MS PowerPoint skills (MS Access/Project Management Skills a plus) and SharePoint and Teams skills required. Demonstrated attention to detail, project management and implementation of processes. Prior remote employment, with a demonstrated ability to self-motive and direct with limited supervision. Ability to research competitive pricing of hospial, ancillary, medical group/IPA and health plan reimbursement preferred. Understanding of Alternate Payment Methodologies preferred.

Req. Certification/Licensure: None. 



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/



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