Molina Healthcare
JOB DESCRIPTION
JOB DESCRIPTION
Overview
The
Senior Analyst, Utilization Management
plays a critical role in supporting clinical and operational initiatives by translating healthcare business needs into technical solutions. This role works closely with clinicians, utilization management teams, and business stakeholders to gather requirements and deliver actionable insights through data analytics. The ideal candidate brings a strong foundation in SQL, Power BI, Databricks, Snowflake, and ETL development, along with a collaborative approach to building scalable, healthcare-focused data solutions supporting utilization management initiatives and conducting trend analyses to identify the underlying drivers of medical cost patterns. Responsibilities
Partner with clinical, operational, and business teams to understand data needs and translate requirements into actionable technical solutions. Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims, authorization, pharmacy, and lab datasets. Build and maintain efficient ETL pipelines to support ongoing reporting and analytics workflows. Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets. Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across the organization. Ensure data quality, governance, and documentation standards are met in all analytics work. Support ad hoc data requests and collaborate cross-functionally to drive data-informed decisions in clinical and business operations. Maintain fluency in healthcare data types (e.g., ICD/CPT codes, HEDIS measures, member eligibility) to guide technical decisions. Job Qualifications
Required Education Bachelor’s or Associate’s degree in Data Science, Computer Science, Analytics, Information Systems, Engineering, or other technology-related fields Required Experience 3–5 years of experience working with healthcare data in analytics or data engineering roles, supporting utilization management initiatives and conducting trend analyses to identify the underlying drivers of medical cost patterns Advanced proficiency in SQL for large dataset analysis and transformation, specifically in processing healthcare claims data and supporting managed care reporting needs Experience using
Power BI
for developing interactive dashboards and data visualizations Hands-on experience with
Databricks ,
Snowflake , or enterprise
cloud data platforms Solid understanding of
ETL concepts
and experience building pipelines for healthcare analytics Strong communication and collaboration skills to work with clinical and business stakeholders Preferred Experience 4+ years in a healthcare analytics role supporting
utilization management, population health, or quality improvement within a Managed Care Organization (MCO) Experience working directly with
clinicians, nurses, or case management teams Familiarity with risk adjustment, value-based care models, or healthcare performance metrics Understanding of regulatory and compliance considerations (e.g., HIPAA) in data handling Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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The
Senior Analyst, Utilization Management
plays a critical role in supporting clinical and operational initiatives by translating healthcare business needs into technical solutions. This role works closely with clinicians, utilization management teams, and business stakeholders to gather requirements and deliver actionable insights through data analytics. The ideal candidate brings a strong foundation in SQL, Power BI, Databricks, Snowflake, and ETL development, along with a collaborative approach to building scalable, healthcare-focused data solutions supporting utilization management initiatives and conducting trend analyses to identify the underlying drivers of medical cost patterns. Responsibilities
Partner with clinical, operational, and business teams to understand data needs and translate requirements into actionable technical solutions. Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims, authorization, pharmacy, and lab datasets. Build and maintain efficient ETL pipelines to support ongoing reporting and analytics workflows. Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets. Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across the organization. Ensure data quality, governance, and documentation standards are met in all analytics work. Support ad hoc data requests and collaborate cross-functionally to drive data-informed decisions in clinical and business operations. Maintain fluency in healthcare data types (e.g., ICD/CPT codes, HEDIS measures, member eligibility) to guide technical decisions. Job Qualifications
Required Education Bachelor’s or Associate’s degree in Data Science, Computer Science, Analytics, Information Systems, Engineering, or other technology-related fields Required Experience 3–5 years of experience working with healthcare data in analytics or data engineering roles, supporting utilization management initiatives and conducting trend analyses to identify the underlying drivers of medical cost patterns Advanced proficiency in SQL for large dataset analysis and transformation, specifically in processing healthcare claims data and supporting managed care reporting needs Experience using
Power BI
for developing interactive dashboards and data visualizations Hands-on experience with
Databricks ,
Snowflake , or enterprise
cloud data platforms Solid understanding of
ETL concepts
and experience building pipelines for healthcare analytics Strong communication and collaboration skills to work with clinical and business stakeholders Preferred Experience 4+ years in a healthcare analytics role supporting
utilization management, population health, or quality improvement within a Managed Care Organization (MCO) Experience working directly with
clinicians, nurses, or case management teams Familiarity with risk adjustment, value-based care models, or healthcare performance metrics Understanding of regulatory and compliance considerations (e.g., HIPAA) in data handling Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#J-18808-Ljbffr