Healthcare Manager, Medicaid Data (T-MSIS) and Payment Model Implementation - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

OptumServe Consulting/The Lewin Group (OSC/Lewin), a premier national health care and human services consulting and policy analysis firm, brings 50 years of experience finding answers and solving problems for leading organizations in the public, non-profit, and private sectors.

In the wide-ranging field of health human services consulting, OSC/Lewin provides both depth and breadth of expertise. Currently, OSC/Lewin has more than 250 consultants drawn from industry, government and academia. They all share a solid commitment to OSC/Lewin's core values of objectivity, integrity, analytical innovation, vision, and dedication to client satisfaction.

At OSC/Lewin, we help federal decision-makers strengthen health and human services programs, make informed policy choices, and implement critical initiatives. OSC/Lewin also works with foundations and associations to research and evaluate complex health care and human services needs. By delivering objective, data-driven research, program planning and development, technical assistance, implementation, post-implementation analytics, and evaluations, OSC/Lewin supports current program activities, informs future program investments and supports strategic decision processes that improve the health and well-being of the nation's citizens.

The Senior Consultant will support Medicaid data and policy work for the CMS Innovation Center's LEAD model. This is a hands-on role. The person will work directly in Medicaid data, including T-MSIS Analytic Files (TAF), and translate model policy into data specifications, code, and results for model operations, including attribution, payment calculations, and quality measurement. This person should be an experienced individual contributor who can independently structure ambiguous analytic work, work closely with policy and task leads, and deliver accurate, well-documented work.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area , you will be required to work in the office a minimum of four days per week .

Primary Responsibilities:

Conduct hands-on analysis of Medicaid data, including T-MSIS data, to support implementation and operations for the LEAD model

Translate model policy and methodology into clear data specifications, business rules, and code for core payment model functions, including beneficiary attribution, payment calculations, and quality measurement

Write, test, and maintain SQL code to build analytic files, define populations, and produce model outputs; use Python where appropriate

Assess Medicaid data quality and completeness across states, account for differences in state data, delivery systems, and managed care and fee-for-service environments, and document how those differences affect model calculations

Link and analyze Medicaid data alongside Medicare data sources, such as data located in the CMS Integrated Data Repository (IDR), as needed to support model methodology

Develop and maintain clear documentation of specifications, code, data sources, assumptions, and quality assurance checks

Perform and support quality assurance of analytic outputs and deliverables, including independent code review and reconciliation of results

Summarize analytic findings and methodology for technical and non-technical audiences, including memos, tables, and presentation materials for CMS

Share Medicaid data knowledge with colleagues and review their work as needed

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Master's degree or higher in public health, public policy, health services research, economics, statistics, epidemiology, data science or another relevelant field, with 6+ years of relevant professional experience; or a Bachelor's degree in a relevant field with 8+ years of relevant professional experience.

2+ years of direct experience working with T-MSIS data

Experience working in the CMS Integrated Data Repository (IDR) in Snowflake or Databricks environments

Experience turning payment model or program policy into data specifications and code, such as attribution, payment, benchmark, or quality measure calculations

Proficiency programming in SQL, including building analytic files from large claims and enrollment datasets

Solid working knowledge of Medicaid eligibility, enrollment, and claims data, including known data quality issues and differences in state reporting

Understanding of Medicaid policy and delivery systems, including fee-for-service and managed care, sufficient to interpret how policy choices affect data and results

Demonstrated ability to independently structure ambiguous analytic assignments, manage competing priorities, and drive work to completion

Solid written and verbal communication skills, with the ability to explain data and methodology clearly to technical and non-technical audiences

Demonstrated attention to detail and ability to produce accurate, well-documented, high-quality work in a fast-moving client-service environment

Ability to work effectively both independently and collaboratively in a multidisciplinary project environment

Preferred Qualifications:

Experience working with Medicaid data across multiple states

Programming experience in Python

Experience supporting a CMS Innovation Center model or another federal healthcare demonstration

Experience with alternative payment models, accountable care, or total cost of care methodologies

Experience working in or directly supporting a state Medicaid agency, CMS, CMCS, CMMI, a Medicaid managed care organization, or a Medicaid data or policy contractor

Consulting experience managing multiple concurrent assignments and responding to evolving federal client priorities

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.