Actuarial Services Manager

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 Care Oregon 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.

$ - $

Bonus - SIP Target, 5% Annual

• 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 Care Oregon’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.

• 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.

• 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, and motivate employees; provide support toward employee development.
• Incorporate guidance from Care Oregon 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.

• Perform work in alignment with the organization’s mission, vision, and values.
• Support…