CareOregon
Join to apply for the
Director, Actuarial Services
role at
CareOregon Job Summary This position is responsible for leading actuarial work across the organization. Work includes but is not limited to value-based payment strategy and provider contracting, supporting the Medicaid and Medicare lines of business, IBNR and reserving recommendations, and supporting the cost and utilization efforts of the organization. Time is focused on business group oversight, as well as enterprise-wide engagement. Primary duties include technical and operational leadership, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization. Essential 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. Strategic/Operational Planning 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. Financial/Resource Management 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. Relationship Management 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. Employee Supervision 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. Experience and/or Education 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 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 Knowledge, Skills And Abilities Required 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 CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
#J-18808-Ljbffr
Director, Actuarial Services
role at
CareOregon Job Summary This position is responsible for leading actuarial work across the organization. Work includes but is not limited to value-based payment strategy and provider contracting, supporting the Medicaid and Medicare lines of business, IBNR and reserving recommendations, and supporting the cost and utilization efforts of the organization. Time is focused on business group oversight, as well as enterprise-wide engagement. Primary duties include technical and operational leadership, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization. Essential 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. Strategic/Operational Planning 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. Financial/Resource Management 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. Relationship Management 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. Employee Supervision 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. Experience and/or Education 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 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 Knowledge, Skills And Abilities Required 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 CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
#J-18808-Ljbffr