[Hiring] Senior Long-Term Care - Rate Setting Analyst @Gainwell Technologies LLC

Role Description

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.

• 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.

Qualifications

• 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.

Requirements

• 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.

Benefits

• Fully remote options from Contiguous US locations only.
• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.