Director, Value Based Payment Actuarial Services
Company: VanderHouwen
Location: Portland
Posted on: March 20, 2023
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Job Description:
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:
Technical/Operational Leadership.
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.
Strategic/Operational Planning
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.
Financial/Resource Management
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.Relationship
Management:
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.Employee
Supervision:
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.Organizational Responsibilities:
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.Preferred:
Minimum Associate of the Society of Actuaries
Experience with value-based provider contracting modelsSkills 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.About
VanderHouwen
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.Thank you for your
interest in applying for this position! Please fill out the fields
below. Your profile will be reviewed with the rest of the
applicants.
Keywords: VanderHouwen, Portland , Director, Value Based Payment Actuarial Services, Accounting, Auditing , Portland, Oregon
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