Healthcare Risk Manager Jobs in Wisconsin (NOW HIRING)

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

We are seeking a dynamic and experienced Healthcare Strategist to join Medica's healthcare economics team. This role is pivotal in developing and implementing data strategies that drive key business decisions within our organization. The ideal candidate will leverage data from various sources to enhance the use of healthcare data, industry standards, benchmarks to inform key stakeholders and partners to support key business decisions, ultimately improving financial performance, member experience and patient outcomes. The strategist will also focus on industry trends in pharmacy and medical services, incorporating benchmarking practices to ensure competitive positioning.

Responsibilities:

• Data Analysis and Insight
• Analyze complex healthcare data to identify trends, patterns, and key performance indicators (KPIs) related to utilization, cost, quality, and member health status.
• Monitor and evaluate industry trends in pharmacy and medical services, including drug pricing, formulary management, and adherence strategies.
• Develop data-driven insights to recommend strategic decisions regarding network development, product design, and risk adjustment strategies.
• Benchmarking and Performance Metrics
• Conduct regular assessments of industry trends in pharmacy and medical services, (e.g., regulatory changes, payer strategies, and emerging therapies).
• Benchmark organizational performance against industry standards and best practices to identify opportunities for improvement and innovation.
• Conduct comparative analyses of Medica's performance against competitors and industry standards, providing insights on core performance KPI's (e.g. cost, rates, utilization, quality, utilization, NPS, and others)
• Business Impact and Reporting
• Create customized reports and dashboards to visualize key metrics, including benchmarking data against industry standards, and communicate actionable insights to stakeholders at various organizational levels.
• Collaborate with business teams to translate data insights into actionable strategies that improve patient care and enhance financial performance.
• Reporting and Technology
• Stay updated on emerging data technologies and analytics tools to enhance analytical capabilities.
• Evaluate and implement new data sources and platforms to support strategic initiatives, particularly in pharmacy and medical benchmarking.
• Present complex analytical concepts and results to both technical and non-technical audiences, ensuring clarity and actionable insights.
• Collaboration and Partnerships
• Manage the lifecycle of data strategy and benchmarking projects and initiatives, including requirements gathering, scoping, resource planning and delivery.
• Collaborate with the key stakeholders to define benchmarking projects and initiatives, deliverables, timing and identify opportunity to include in normal business cycles.
• Partner and represent Medica with key vendors on analytical benchmarking initiatives and projects.
• Continuous Improvement
• Stay abreast of healthcare trends, best practices and regulatory changes affecting benchmarking and healthcare analytics.
• Identify opportunities for process enhancements and promote data-driven culture within the organization.
• Population Health Management
• Identify high-risk patient populations through data analysis and partner internally to develop targeted interventions to improve health outcomes.
• Monitor and evaluate the effectiveness of population health management programs using data analytics.
• Business Acumen
• Develop, document, and maintain operating playbooks, workflows, and standard operating procedures for analytics processes, ensuring consistent and well documented methodologies.
• Ensure compliance with all applicable laws and regulations in analytics practices.
• Perform other duties as assigned.

Qualifications:

• Bachelor's degree in Data Science, Mathematics, Healthcare Analytics, Healthcare Economics or equivalent experience in related field, Masters preferred
• 7 years of work experience beyond degree in healthcare analytics or data driven roles within the healthcare or insurance industries with a focus on leveraging benchmarking tools and methodologies.
• Highly advanced working knowledge and skill of professional field with ability to provide direction on very complex projects
• Strong proficiency in data analysis tools (e.g., SQL, Python, R, Excel) and visualization techniques/software (e.g. Power BI, Tableau)
• Proven experience in developing and implementing data standards and best practices within an analytical environment.
• Proficiency in Microsoft Office applications including Word, PowerPoint, Excel, and Access.
• Demonstrated ability to design, evaluate, and interpret complex data sets, with strong analytical and problem-solving skills.
• Excellent written and verbal communication skills, capable of conveying complex information clearly and concisely to diverse audiences.
• Experience working both independently and collaboratively in cross functional teams, engaging with individuals from diverse professional backgrounds.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Internal Applicants: We're excited about your interest in growing your career at Medica! To be eligible to apply for internal opportunities, employees must have been in their current role for at least one year.

Recruiter: Michael Benson

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.