Family HealthCare Network · 13 hours ago
Managed Care Analyst
Visalia, CA
Full-time
Onsite
Entry, Mid Level
$70K/yr - $112K/yr
2+ years expFamily HealthCare Network is seeking a Managed Care Analyst to utilize health plan data for revenue growth and compliance reporting. The role involves data validation, analysis of payer relationships, and producing reports to support organizational revenue goals.
Health CareNon ProfitWellness
Responsibilities
Responsible for producing, validating, and interpreting data for health plan membership and capitation reports and developing internal status reports to meet organizational revenue goals
Defines data requirements and develops data collection and analysis tools for payer-specific identities
Performs data validation to ensure integrity of reporting
Identifies, investigates, and reports discrepancies in the data or workflows
Maintains a work plan for post-production reports and presentations
Produces monthly reports on payer revenue
Maintains Compliance Data Base for all Health Plans and special projects
Uses collected data to evaluate the profitability of payer relationships for all lines of business:
Medicare and Medicare Advantage Five Star Performance
Medi-Cal Managed Care Health Plan Audit/Compliance and Incentives
Commercial Health Plans P4P and HEDIS Performance
Health plan contract modeling
Analyze utilization data such as PCP visits, ER visits, hospital admissions, and bed days and identify opportunities to control utilization
Assists data analysis efforts of other FHCN staff and departments as needed
Responsible for assessing the effectiveness of internal workflow impact on health plan revenue streams and ensuring current organizational policies follow existing contract terms
Other duties as assigned
Qualification
Required
Bachelor's degree in finance, Math, Business, IS, or a related field
Two to three years of relevant experience, including experience with healthcare, preferably in managed care
Two-plus years of data analysis or financial modeling
Strong analytical and problem-solving skills
Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs, and other elements
Ability to use Advanced Microsoft Excel to analyze data, including formulas, functions, lookup tables, and other standard spreadsheet elements
Ability to develop sophisticated presentations in Microsoft PowerPoint, including embedded objects, transitions, and other elements
Job duties require employees to effectively communicate their opinions and extrapolations of information they collect, synthesize/analyze
Exercises tact and diplomacy to resolve mild conflicts or disagreements
Compiles, analyzes and prepares information in an effective written form, including correspondence, reports, articles, or other documentation
Effectively conveys technical information to non-technical audiences
Company
Family HealthCare Network
Family HealthCare Network is a non-profit community-based organization offering a comprehensive primary healthcare delivery system.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$0.73M2013-11-11Grant· $0.73M
Leadership Team
Chad Vawter
Deputy CEO and Senior VP
Recent News
The Business Journal
2025-07-19
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