Senior Long -Term Care - Rate Setting Analyst

Summary: As a Senior Long-Term Care - Rate Setting Analyst at Gainwell, you will take a lead role in developing and maintaining rate‐setting methodologies that support a large, complex Medicaid long‐term care program. You will apply deep data expertise, interpret policy impacts — particularly within Wisconsin Medicaid — and understand how rate decisions affect Managed Care Organizations (MCOs) and the broader long‐term care ecosystem. Bring your analytical strengths and passion for public service to a team committed to improving program transparency, efficiency, and outcomes for the communities we serve. Here are the details on this position.

In Our Mission: Play a critical part in ensuring rate‐setting and reimbursement strategies meet program, policy, and organizational goals. Lead the development, enhancement, and documentation of rate‐setting models for long‐term care programs Use advanced analytical techniques and large datasets to evaluate costs, trends, and reimbursement outcomes Assess how rate changes, policy updates, and cost drivers affect Managed Care Organizations (MCOs) Translate business needs into clear data, system, and policy requirements Research reimbursement methodologies, program operations, and the long‐term care ecosystem to recommend improvements Support the development and implementation of capitated rate‐setting methodologies for contracted MCOs Validate the accuracy and sufficiency of rates produced by established models Monitor State and Federal policy changes — with emphasis on Wisconsin Medicaid — and assess their operational and financial impact Partner with internal teams, business leaders, and external stakeholders to promote transparency and alignment in rate‐setting practices Prepare written analyses, presentations, and recommendations for leadership, clients, and technical teams What We're Looking For 6+ years of experience in business analysis, financial modeling, health policy analysis, Medicaid policy analysis, public administration, or public sector program evaluation Strong data expertise, including understanding how rate-setting decisions impact Managed Care Organizations (MCOs) Experience interpreting public policy, preferably within healthcare and/or Wisconsin Medicaid Understanding of the Long-Term Care (LTC) ecosystem, including program structures and reimbursement models Advanced skills in Excel and/or analytical tools such as R, SAS, STATA, or SPSS Strong statistical analysis, quantitative modeling, and data interpretation skills, with the ability to translate complex findings into actionable recommendations Strong communication skills to translate complex analytical work into clear, actionable insights Ability to work independently, manage timelines, and support multiple projects at once Bachelor's degree in Public Administration, Public Policy, Economics, Statistical Analysis, Healthcare Administration, Finance, or a related field; master's degree preferred What Sets You Apart Experience evaluating government, business, or healthcare policies that affect internal and external partners Experience working with Medicaid programs, rate-setting methodologies, or capitated payment models Experience analyzing large datasets and developing quantitative or statistical models Ability to write and present comprehensive reports, analyses, and policy summaries Strong problem-solving skills and a track record of recommending improvements to business or technical processes Experience with SQL or data warehouse tools Education or training in public policy, economics, statistics, or a related field Familiarity with State/Federal regulations influencing long-term care and Medicaid operations Professional experience working within a state Medicaid agency, state policy office, healthcare policy organization, or government-funded healthcare program Experience working for or directly supporting Managed Care Organizations (MCOs), including an understanding of managed care financing and oversight Knowledge of Medicaid policy, healthcare reimbursement methodologies, actuarial concepts, and capitation rate development Experience evaluating the financial and operational impacts of capitation rates, rate adjustments, and value-based payment arrangements What You Should Expect In This Role Fully remote options from Contiguous US locations only Video cameras must be used during all interviews, as well as during the initial week of orientation Photo will be taken during screening for verification in all steps of the recruitment process. This posting is intended for pipelining. This is a developing position therefore the job description is subject to change. Please ensure you join all screenings, interviews and meetings from a quiet location with a stable internet connection. Video is required for screenings and interviews, so please test your camera and microphone in advance. Do not use AI tools, virtual backgrounds/filters, or visual enhancements during the interview. The pay range for this position is [[salary Min]] - [[salary Mid]] per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth.