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CareOregon · 3 months ago

Director, Actuarial Services

United States

Full-time

Remote

Director/Executive

$204K/yr - $249K/yr

10+ years exp

CareOregon is a healthcare organization focused on providing quality services to its members. They are seeking a Director of Actuarial Services to lead actuarial work, including value-based payment strategy, provider contracting, and financial analysis to support Medicaid and Medicare lines of business.

Health Care

Responsibilities

Directs actuarial services across the organization in support of Medicaid, Medicare, and other populations

Leads the execution of strategic initiatives, plans, and goals for areas of oversight in alignment with organizational vision and goals

Leads in developing, evaluating, and maintaining the financial terms of value-based payment models for the organization to support delivery system transformation in partnership with internal and external teams (e.g., PCP Payment Model, Risk Agreements)

Advises leadership on ways to improve CareOregon’s strategic and financial positioning to support its current and future provider network and strategic partners; collaborates with leadership in the development and negotiation of complex contractual and financial arrangements with complex providers (e.g., hospitals, primary care physicians and ancillary providers)

Provides Medicaid rate setting support through data analysis, policy review and strategy development. Identifies any actuarial unsound adjustments to the rates

Provides oversight of Medicare Advantage bid process. Collaborates with Medicare department in setting strategy

Ensures complete and accurate encounter data is submitted to support the rate setting process

Develops profitability analytics to support evaluation by provider group, condition and other indicators

Monitors risk adjustment applied to capitation revenue and leads effort to ensure population risk is appropriately represented in encounter data

Reviews and provides guidance on actuarial estimates of IBNR, PDR and other actuarially determined assets and liabilities

Leads in developing and maintaining cost and utilization analyses for the organization. Identifies actionable opportunities to improve financial and clinical performance and communicates findings throughout the organization

Oversees and ensures the timely completion of required regulatory reporting

Engages and oversees the work of outside actuaries to support their work and ensure the company’s interests are represented

Effectively articulate and disseminate models and innovation results using a variety of communication channels to include written reports, graphic data display, PowerPoint presentations, speaking engagements, and manuscript publications

Provide oversight of the development and maintenance of policies, procedures, structures and training to support the staff and department into the future

Leads department efforts to incorporate advanced data analysis and communication tools such as R, Python, Tableau, and/or Power BI into workflows

Participates in the development of vision, goals, and strategic plans for the Finance Department, as well as provider contracting team

Develops short- and long-term plans and policies; oversees the development and execution of standard operating procedures

Provides input into strategic plans of the organization

Maintains a business unit and member view while establishing department priorities, being cognizant of broader business unit and organizational impacts

Recommends budgets in alignment with short- and long-term plans

Manages resources to ensure priorities are accomplished

Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions

Leads effective communication system for work group(s), ensuring a collaborative culture

Builds and ensures effective relationships across internal teams and external organizations for current or future integration

Partners with internal leaders and managers in identifying improvement plans and processes

Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness

Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values

Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens

Identifies department priorities; ensures employees have information and resources to meet job expectations

Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff

Manages, coaches, motivates, and guides employees; promotes employee development

Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making

Ensures team adheres to department and organizational standards, policies, and procedures

Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action)

Performs supervisory tasks in collaboration with Human Resources as needed

Qualification

Actuarial servicesValue-based payment modelsMedicaidMedicareFinancial analysisData analysisStrategic planningRelationship managementLeadershipPeople managementResource managementMathematical analysisData managementCommunication skillsProblem-solving skillsCritical thinkingTeam managementPresentation skills

Required

Minimum 10 years' experience in actuarial services, finance, or analytics

Work experience in health insurance, preferably Medicaid and Medicare

Minimum Associate of the Society of Actuaries

Extensive knowledge of managed care and the Oregon Health Plan

Knowledge of federal Medicare regulations and state Medicaid rules (OARs)

Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies

Demonstrated depth of experience in building relationships with multiple entities, including providers and community stakeholders

Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level

Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills; ability to influence and build consensus

Ability to communicate complex payment models to non-technical individuals

Demonstrated leadership effectiveness and ability to design and implement constructive change

Strong people management skills, including the ability to coach and motivate teams

Excellent critical thinking and problem-solving skills

Ability to produce or assess mathematical analysis, models and financial principles pertaining to managed care

Strong data management skills. Proficient in working with relational databases

Ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement

Ability to effectively convey business unit goals and plans ensuring integration into strategic plans/initiatives

Highly skilled in resource management

Ability to work in an environment with matrix reporting, diverse individuals and groups

Ability to learn, focus, understand, and evaluate information and determine appropriate actions

Ability to accept direction and feedback, as well as tolerate and manage stress

Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Preferred

Bachelor's Degree in Actuarial Science, Finance, Mathematics, Economics or related field

Fellow of the Society of Actuaries

Minimum 4 years' experience in a supervisory position

Experience with value-based provider contracting models

Benefits

Medical

Dental

Vision

Life

AD&D

Disability insurance

Health savings account

Flexible spending account(s)

Lifestyle spending account

Employee assistance program

Wellness program

Discounts

Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)

Strong retirement plan with employer contributions

PTO

Paid State Sick Time

Paid holidays

Volunteer time

Jury duty

Bereavement leave

401(k) contributions

Wellness and employee assistance program benefits

Other perks