Actuarial Services Director jobs in the United States

Summary / Objective:

The Director of Actuarial Services and Medical Economics partners with the CFO and Finance Leaders of PSW and MultiCare to understand and optimize risk-based contracts, value-based contracts and population health strategies throughout the system. The incumbent maintains a deep understanding of the impacts of these strategies on the organization and assists the operational teams in adopting methods to optimize performance under the risk-based and value-based contracts in ways that are consistent with PSW and MultiCare’s population health strategies.

Essential Functions:

• Builds analytical and decision support models to determine population health utilization metrics (e.g. admits per thousand), traditional hospital revenue drivers (e.g. inpatient admissions), and total medical expenditures for Medicare, Medicaid, and commercial populations participating across contracting models (e.g. BPCI, MSSP 1 , CMMI, etc.) with ability to analyze key assumptions and recommend contracting strategies, product design, network design and operational performance.
• Supports strategic planning and annual budgeting process.
• Develops models and processes to estimate claims incurred but not reported (IBNR) associated with the Employee Health Plan and value-based contracts as applicable.
• Leads development of reporting mechanism to support complete and accurate capture of all clinical diagnoses for MHS and MultiCare Connected.
• Designs and maintains system and processes to capture and report quality metrics by provider, practice, and payer.
• Provides financial analysis and rationale for population health-based strategies.
• Oversees staff providing direction and guidance and administering management functions within the provisions of MultiCare policies and standards and federal, state and local regulations.
• Leads and executes communication and finance-related initiatives for MHS.
• Works closely with Finance team to understand the implications of risk-based contracting and population health.
• Serves as the “Go To” person throughout the region by being visible, approachable, and viewed widely as a problem solver and a valued resource.
• Partners with the VP Finance and other senior level finance leaders to create a high functioning actuarial and medical economics team that delivers effective payer and network management strategies and operations to the system.
• Organizes, analyzes, and presents high value analysis and interpretation of data in support of the finance and strategic planning functions.
• Identifies opportunities for improvement and leads the execution of financial improvement opportunities, partnering with business unit leaders to translate financial targets into actionable operating objectives.
• Identifies, evaluates, and recommends areas of growth for MHS and MCC.
• Acts as liaison between the Network and the broader finance and revenue cycle teams.
• Participates in the annual budget process for the Network, in alignment with the system process and in the performance of complex research and financial projects analysis.
• Works with the respective Interdependent Business Unit leadership teams to identify short and long-term measures of success and routinely identifies specific deliverables from finance to support achievement of these success measures.

Knowledge/Skills/Abilities:

• Knowledge of the principles of healthcare economics for provider and health plan organizations in order to effectively analyze and make decisions
• Knowledge of hospital, medical group and health plan operations and the roles, responsibilities and activities of clinically integrated networks
• Knowledge of medical economics, actuarial services, general accounting, cost accounting, and cost analysis in the health plan and provider setting
• Knowledge of current CMS Innovation Models
• Excellent financial and analytical skills, as well as insightful business acumen
• Strong customer service orientation
• Skill in complex spreadsheet analysis and statistical measures
• Skill and proficiency with Microsoft Excel, Word, Outlook, SQL and SAS
• Skills in completing proformas and business plans for large service lines and new programs
• Skill in good oral and written communication
• Skill in time management, ability to prioritize independently
• Ability to apply a test of reasonableness to each analysis and to question results before the task/analysis is complete
• Ability to communicate technical information regarding financial and information systems to Executives, Directors, Managers and Staff
• Ability to analyze data from internal and external databases
• Ability to think creatively, work independently and take initiative
• Ability to work efficiently under pressure and meet committed deadlines
• Skill in directing the work and activities of staff with the ability to delegate effectively
• Skill in providing leadership and in the mentoring of staff
• Skill in time management and ability to meet deadlines
• Skill in creating high-performing teams
• Ability to establish a climate that achieves optimal performance levels
• Ability to establish and maintain a cohesive work team
• Ability to accept responsibility willingly
• Ability to set priorities and use good judgment
• Proactive team player, strong follow through, quick decision-making abilities and ability to problem solve.
• Interpersonal skills, with the ability to build strong relationships at all levels.
• Strong verbal and written communication skills with customers, supervisors, and co-workers.
• Strong organizational, time management and prioritization skills.
• Self-starter. Ability to set priorities and keep to projected schedules.
• Excellent computer proficiency (MS Office – Word, Excel, and Outlook) including being able to effectively maintain written and computer records in accordance with regulatory agencies.