Director, Actuarial Services

Join to apply for the Director, Actuarial Services role at Care Oregon

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.

Essential Responsibilities

• 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.
• Provide 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.

Estimated Hiring Range
: $ - $

Bonus Target
:
Bonus - SIP Target, 10% Annual

Experience and/or Education

• Required
  :
  Minimum 10 years’ experience in actuarial services, finance, or analytics, Work experience in health insurance, preferably Medicaid and Medicare, Minimum Associate of the Society of Actuaries
• Preferred
  :
  Bachelor’s Degree in Actuarial Science, Finance, Mathematics, Economics or related field, Fellow of the Society of Actuaries, Minimum 4 years’ experience in a supervisory position, Experience with value-based provider contracting models

Knowledge,

Skills And Abilities

Required

Knowledge

• Extensive knowledge of managed care and the Oregon Health Plan
• Knowledge of federal Medicare regulations and state Medicaid rules (OARs)
• Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies

Skills And Abilities

• D…