Job Id: 59460
Director, Value Based Payment Actuarial Services:
This position is responsible for leading the actuarial and financial components of the value-based payment strategy and activity across 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.
This position is onsite.
Director, Value Based Payment Actuarial Services Responsibilities:
Directs actuarial value-based payment services across the organization in support of Medicaid, Medicare, and other populations.
Leads in developing, evaluating, and maintaining the financial terms of value-based payment models for the organization.
Leads the execution of strategic initiatives, plans, and goals for areas of oversight in alignment with organizational vision and goals.
Develops, operationalizes, and maintains effective financial models to support delivery system transformation in partnership with internal and external teams (e.g., PCP Payment Model, Risk Agreements).
Ensures Network and VBP strategies are supported by evidence based and best practices that relate to the models being developed; integrates findings into the design of methodologies.
Works with internal leaders in the development, implementation, and maintenance of quality payment strategies and risk models within regional networks.
Advises leadership on ways to improve 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).
Develops and maintains process to evaluate financial and network impact of alternative payment methodologies including member attribution logic and continually review and adjust strategies accordingly.
Assists in the development, implementation and maintenance of analytical plans and evaluation plans of developed models in quality of care, health care utilization, and cost trends as necessary for the program.
Oversees and ensures the timely completion of value-based payment regulatory reporting, such as the Payment Arrangement File.
Provide oversight of the development and maintenance of policies, procedures, structures and training to support the staff and department into the future.
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.
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 the company 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 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.
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.
Director, Value Based Payment Actuarial Services Qualifications:
Minimum 10 years’ experience in actuarial services, finance, or analytics.
Minimum 4 years’ experience in a supervisory position.
Work experience in health insurance, preferably Medicaid and Medicare.
Bachelor’s Degree in Actuarial Science, Finance, Mathematics, Economics or related field required.
Minimum Associate of the Society of Actuaries
Experience with value-based provider contracting models
Skills and Abilities:
Extensive knowledge of managed care and the Oregon Health Plan.
Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies.
Knowledge of complex and alternative reimbursement arrangements.
Knowledge of federal Medicare regulations and state Medicaid rules (OARs).
Knowledge of claims administration and ability to analyze whether contract reimbursement terms are being processed correctly.
Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), and ability to perform rate calculations.
Knowledge of physician group, hospital, and facility reimbursement.
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 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.
Ability to recommend and negotiate complex contractual VBP models to align with specific regulatory requirements, corporate initiatives, strategies, goals and objectives.
Excellent critical thinking and problem-solving skills.
Ability to produce or assess mathematical analysis, models and financial principals pertaining to managed care.
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 and initiatives.
Highly skilled in resource management.
Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills.
Ability to influence and build consensus.
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.
Salary: $160,500k-$240,800k/yr. (DOE)
VanderHouwen is an award-winning, Women-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen has been successfully placing experienced professionals throughout the Pacific Northwest and nationwide. Our recruitment teams are highly specialized in either Technology and IT, Engineering, or Accounting and Finance career markets. Our recruiters value building meaningful, professional relationships with each candidate as well as developing honed knowledge of companies' staffing needs and workplaces. Partner with us to land your next exciting career.
VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state or federal civil rights laws.
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