Director, Actuarial Services

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.

• 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 Care Oregon’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.
• Provides 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.

• 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…