CareOregon
Overview
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 Technical/Operational Leadership
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.
Estimated Hiring Range
$203,535.00 - $248,765.00
Bonus Target
Bonus - SIP Target, 10% Annual
Experience and/or Education 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
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 Knowledge
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
Skills And Abilities
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
Working Conditions Work Environment(s): Indoor/Office; Travel may include occasional required or optional travel outside of the workplace. Work from home.
We are an equal opportunity employer. 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.
Seniority level
Director
Employment type
Full-time
Job function
Management and Manufacturing
Industries
Insurance
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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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 Technical/Operational Leadership
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.
Estimated Hiring Range
$203,535.00 - $248,765.00
Bonus Target
Bonus - SIP Target, 10% Annual
Experience and/or Education 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
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 Knowledge
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
Skills And Abilities
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
Working Conditions Work Environment(s): Indoor/Office; Travel may include occasional required or optional travel outside of the workplace. Work from home.
We are an equal opportunity employer. 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.
Seniority level
Director
Employment type
Full-time
Job function
Management and Manufacturing
Industries
Insurance
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr