Job Summary This position is responsible for managing the actuarial and financial components of value-based payment (VBP) activity and provider network reimbursement models across the organization. This includes providing input in the development of VBP and other reimbursement models, operationalizing reporting and settlement calculations, analyzing performance, and communicating results and findings within CareOregon and to external partners. Primary duties include technical and operational management, as well as relationship and people management. This position provides input into strategic plans for the Finance unit.
Estimated Hiring Range:
$167,130.00 - $204,270.00
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
Essential Responsibilities
Technical/Operational Management
Work with the Director, Actuarial Services to execute value-based payment plans and goals in alignment with organizational vision and goals.
Collaborate with internal leaders to develop, implement, and maintain quality incentive payment strategies and risk models within regional networks.
Advise leadership on ways to improve CareOregon’s strategic and financial positioning to support its current and future provider network and strategic partners; collaborate 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).
Act as a subject matter expert on value-based payment models for internal stakeholders and external partners.
Develop, operationalize, and maintain actuarial and financial models to support provider payment models for Medicaid, Medicare, and other populations.
Develop and maintain process to evaluate financial and network impacts of alternative payment methodologies and continually review and adjust strategies accordingly.
Ensure monthly and quarterly reporting is produced in accordance with contractual terms, settlements are calculated correctly and promptly, and payments are made in a timely manner.
Analyze performance and explain drivers of results in value-based payment models. Identify potential opportunities to reduce costs and/or improve quality.
Effectively articulate and disseminate provider payment models and results using a variety of communication channels that include written reports, graphic data displays, and PowerPoint presentations.
Develop meeting materials and present to Joint Operating Committee meetings to support providers engaged in value-based payment models.
Ensure the timely completion of value-based payment regulatory reporting, such as the Payment Arrangement File.
Relationship Management
Communicate effectively, encouraging and creating a collaborative culture within Finance and cross-functionally.
Build and ensure effective relationships across internal teams and external organizations for current and future integration.
Partner with internal leaders and managers in identifying improvement plans and processes.
Employee Supervision
Manage team and recommend team direction and goals in alignment with the organizational mission, vision, and values.
Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
Train, supervise, motivate, and coach employees; provide support toward employee development.
Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
Ensure team adheres to department and organizational standards, policies, and procedures.
Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
Perform supervisory tasks in collaboration with Human Resources as needed.
Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision, and values.
Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Experience and/or Education
Required
Minimum 5 years’ experience in actuarial services related to health care
Associate of the Society of Actuaries
Preferred
Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program
Fellow of the Society of Actuaries
Experience with value-based provider contracting models
Work experience in health insurance
Experience with Medicaid and Medicare
Bachelor’s Degree in Actuarial Science, Finance, Mathematics, Economics, or related field required
Knowledge, Skills and Abilities Required
Knowledge
Extensive knowledge of managed care
Knowledge of physician group, hospital, and facility reimbursement
Knowledge of complex and alternative reimbursement arrangements
Knowledge of claims administration and ability to analyze whether contract reimbursement terms are being processed correctly
Strong understanding of data systems and relational databases
Skills and Abilities
Excellent critical thinking and problem-solving skills
Ability to develop and assess actuarial analyses and models pertaining to managed care
Ability to communicate effectively, both verbally and in writing, including strong presentation skills
Ability to develop and lead high performing team members, including hiring, goal setting, coaching, performance management, and career development
Effective leadership skills and advanced understanding of managerial concepts and techniques in areas such as work planning, training, delegating, coaching, mentoring, and evaluating staff
Advanced Excel skills
Proficient with SAS, SQL, and/or R
Ability to develop and maintain Tableau dashboards
Ability to work with eligibility data, claims data, risk scores, and other financial data
Ability to identify, implement, and manage process improvements
Ability to work effectively with 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 ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
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.
