Job Description

- Managed Care (Full-Time, Day Shift) -

Our mission is to participate in Jesus Christs ministry, bringing health, healing, and wholeness to humanity by creating a supportive faculty practice framework. This framework allows Loma Linda University School of Medicine physicians and surgeons to educate, conduct research, and deliver quality health care with optimal efficiency. We aim to deploy a motivated and competent workforce trained in customer service and whole person care principles, providing safe, seamless, and satisfying health care encounters for patients while upholding the highest standards of fiscal integrity and clinical ethics. Our core values are compassion, integrity, humility, excellence, justice, teamwork, and wholeness.

The Performance Analyst supports Managed Care leadership by providing data management and analytics related to the management of Medicare Advantage and commercial populations, as well as associated contract performance. The role involves designing and implementing metrics for operational and financial performance, creating dashboards, and tracking RAF/Risk Adjustment scores. The analyst forecasts clinical and financial data impacts, ensures compliance with CMS and DMHC regulations, and fulfills reporting requirements. Performs other duties as assigned.

Qualifications

• Bachelor's Degree in business, healthcare analytics, or a related discipline required. Minimum four years of experience in managed care data analytics and/or management required. An additional four years of experience may substitute for a degree.
• Understanding of managed care data analytics, including capitation, utilization management, claims, case management, financial analysis, and HCC coding, is required. Knowledge of CMS and DMHC regulations is essential. Experience with performance improvement methodologies is highly desirable.
• Proficiency in data management, MS Excel, report and graphics development, and analytics platforms required. Ability to keyboard 40 wpm. Competence in using computers, printers, and necessary software (Word, Excel, Outlook, PowerPoint). Ability to operate/troubleshoot basic office equipment.
• Must be able to work calmly under pressure, collaborate, accept direction, think critically, manage multiple tasks, organize workload, and work independently. Attention to detail, color distinction, hearing, and visual acuity are necessary for the role.

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