Durham, North Carolina
Durham, North Carolina
Corning, New York
Durham, North Carolina
Durham, North Carolina
Durham, North Carolina
Durham, North Carolina
Durham, North Carolina
San Antonio, Texas
Morristown/NJ/USA
Durham, North Carolina
Posted: 08-Mar-23
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 9880804
Summary:
This position directs the fiscal functions of the CHRISTUS Networks Division, which includes Health Plans and Population Health (Accountable Care Organization and Clinically Integrated Network), in accordance with generally accepted accounting principles issued by the Financial Accounting Standards Board, the Securities and Exchange Commission, State Department of Insurance other regulatory and advisory organizations.
This position is responsible for making critical business judgments and recommendations for existing and new business development in the Medicare, Health Insurance Exchange, Uniformed Services Family Health Plan, Nueces County Hospital District Indigent Care Program, Medicare Shared Savings ACO, CIN Managed Care value-based care agreements, and Third-Party Administration products. The incumbent will lead and manage the finances of the organization in collaboration with other health plan and population health executives and report directly to the Senior Vice President, Population Health and Health Plans. This position will provide financial reports to the Health Plan Boards, ACO and CIN Boards, and be responsible for reporting the financial position of the company to external regulatory agencies. The position is responsible for overseeing the actuarial and analytics functions of the organization, including, but not limited to, the annual bid process for applicable products, the financial analysis function, and the annual budgeting process. Actuarial Services can be managed through vendor relationships when needed and appropriate.
The incumbent must have a proven financial background with a deep understanding of the managed care insurance business. The incumbent must demonstrate an ability to think strategically while managing both short-term and long-term goals. Strong communication skills are required to communicate strategy to top-level executives while also managing all levels of staff.
Education:
- Bachelor's degree in business or related field required.
- Master's degree in Business Administration, Mathematics or related field preferred
- CPA preferred.
- Actuarial skills and background helpful.
Experience:
- Seven or more years of experience in health plan financial management and/or actuarial function, with experience as a health plan CFO Pricing or Actuary preferred. Managed care and/or Medicare Advantage plan experience preferred.
- A strategic thinker and tactical executor who is able to move an agenda from concept to reality and drives results and organizational improvement through performance outcomes.
Skills:
- Works independently, accountable for decisions that impact the entire business.
- Demonstrates strong interpersonal and project management skills, with an aptitude for building high-performance, cross-functional teams.
- Experience in fostering a culture of embracing new ideas.
- Has managed dynamic and differing needs, interests and viewpoints of multiple stakeholders.
- Demonstrates a strong commitment to Health Plan's mission and the people the company.
- Makes best use of resources and creating opportunities; comfortable assessing and taking risks.
Major Responsibilities:
- Serves as corporate Officer for Health Plan entities in both Texas and Louisiana with the respective Departments of Insurance.
- Provides leadership for all health plan financial operations (accounting, budgeting, finance, long range and capital planning, financial reporting, actuarial functions).
- Provides leadership for health plan enrollment, eligibility and billing operations, in coordination with departmental management.
- Leads and directs actuarial function in annual bid preparation process, risk management initiatives, and other ad-hoc analysis in support of the strategic initiatives of the organization.
- Development and coordination of financial management systems necessary to achieve health plan financial goals.
- Identifies opportunities for improvement and communicates these to senior leadership.
- Accountable for the profitability of the health plans in conjunction with the CEO and executive team.
- Develops and maintain effective relationships with key contacts at applicable regulatory agencies; function as primary contact for all financial related inquires, including, but not limited to state Departments of Insurance, state Medicaid agencies, the Department of Defense (DoD) and the Center for Medicare and Medicaid Services (CMS).
- Plans and coordinates all aspects of health plans Finance Committee meetings.
- Develops and presents financial reports as needed to present financial results to key audiences (e.g. Boards, partners, CMS, management, legislators).
- Participates on health plan's negotiating team for annual state and federal contract renewal and interim rate increases; work with Actuaries to develop appropriate rate proposals by category of aid.
- Participates in contract negotiations related to regional expansion.
- Creates cost benefit analyses to support business, including but not limited to: provider rate negotiations, subcontractor rate negotiations, financial proformas, and provider incentive programs.
- Develops and administers health plan financial policies and procedures.
- Coordinates preparation of monthly financial statements.
- Ensures required financial reports are filed with appropriate state agencies in a timely, accurate manner.
- Provides support to external and internal auditors.
- Coordinates the approval and processing of operating expenses in accordance with guidelines approved by Finance Committee.
- Establishes credibility throughout the organization with management and the associates in order to be an effective listener and problem solver of people issues.
- Develops specific and measurable performance standards for all direct reports. Holds self and others accountable to goals and standards of department and company.
- Guides and encourages career development, conducts timely performance evaluations and provides open/ongoing constructive feedback to all direct reports.
- Leads by example: Sets an example of personal performance, which encourages excellence and integrity.
- Assists in the establishment and achievement of business objectives for the area of responsibility based upon company's overall strategic plan and operating goals.
- Maintains current knowledge of and applies all applicable licensing, regulatory and industry standards. Keeps abreast of current industry trends.
- Writes, speaks and presents clearly and concisely. Is thoroughly prepared prior to beginning any negotiation or conflict resolution process.
- Assess departments work quality and develops/implements process improvements to improve and achieve regulatory and oversight compliance
