HSCSN Fin Program Director

JOB SUMMARY

The Director of Finance, Managed Care will assist the VP of Finance by acting as his primary backup in all functions related to financial operations, budget development, provider contracting, business analytics and planning functions. The VP of Finance will work side-by-side with the Director of Finance in all fiscal matters related to managing the $190 million managed care services budget.



Minimum Education
Bachelor's Degree Bachelor's degree in finance, Business or Accounting (Required)
Master's Degree (Preferred)

Minimum Work Experience
10 years Health care financial management experience with managed care (Preferred)
5 years Finance leadership roles (Required)

Required Skills/Knowledge
Must be proficient in Microsoft Word, Excel and Outlook.
Analyze data, generate reports through Pivot tables, and excel spreadsheets.
Ability to extract data using a variety of commercially available tools including MS Excel, MS SQL tools, including the ability to learn new analytics tools such as Tableau, Power BI, etc. Ideal fit will be an Excel guru comfortable with advanced data manipulation functions.
Medicaid Managed Care of Health Plan Operations experience
Monitor and report financial performance of provider and vendor contracts and ensure compliance with contracting guidelines.
Experience with department budgeting, financial reporting, and budget review
Develops, secures approval of and administers a budget, (including a capital budget), that provides for the attainment of agreed upon goals and objectives in accordance with approved plans, and providing efficient and cost effective utilization of resources.
Manages project execution to ensure adherence to budget, schedule, and scope.
Experience with department budgeting, financial reporting, and budget review
Analyzes data to forecast and interpret potential trends in population health, and to ask/answer questions about medical claims, membership, care management, utilization management, etc.
Extensive experience in major customer contracting involving integrated commercial organizations
Excellent interpersonal and relationship management skills
Excellent oral, written and presentation skills
Proven ability to foster collaboration, value others' perspective and gain support and buy-in for organizational proposals
Proven ability to drive and lead organization through significant change
Proven success in managing growth of business operations
A strong knowledge of strategic planning, data analytics, and management dashboard development
Ability to apply data and analytics to solve complex, impactful problems
Strong knowledge of business intelligence software and major enterprise systems

Required Licenses and Certifications
CPA License Upon Hire (Preferred)

Job Functions

• 1. Oversee all finance related activities for managed care entity including developing and monitoring progress against annual budget, identifying medical cost trends and participating in medical cost improvement initiatives.

• 2. Responsible for implementing CMS, DHCF, and DISB requirements related to medical loss ratio reporting, fiscal soundness reporting, audit assistance, and analysis of service utilization, drug utilization, and other cost trends. Lead all internal and external reporting activities.

• 3. Manage and monitor finance activities related to Master Services Agreement (MSA) with Children’s and the related division of responsibilities.

• 4. Lead rate-setting activities by coordinating activities with DHCF and its consulting actuary.

• 5. Provide insight and analysis with respect to provider contracting and data analytics activities particularly in the area of Value Based Purchasing (VBP). Support Provider Relations business unit with the development of financial payor models and benchmark comparisons to support contractual decisions, including assumptions, observations, conclusions, and recommendations.

• 6. Plan, develop, and prepare complex reimbursement models, including but not limited to value-based payment and reimbursement, population health management, risk, and capitation to determine payor contract proposed terms.

• 7. Review and analyze statistical, cost, and financial reports for complex payor contracts.

• 8. Conduct retrospective review of claims payment history (Lag Report, PM/PM Report).

• 9. Monitor the volume of monthly authorizations and provide projections on the potential financial impact

• 10. Validate accuracy capitation revenue payments and reconcile with available sources, including QNXT, 820, and 834 files.

• 11. Keep abreast of financial and regulatory matters affecting managed care services. Take all reasonable steps to ascertain that the company conforms to applicable federal and local laws and regulations relating to financial issues.

• 12. Lead establishment of organizational and departmental performance metrics. Review performance against those benchmarks and implement corrective action plans as necessary.

• 13. Review monthly performance and financial results of the business unit and provide recommendations to senior management. Design and implement analytical financial dashboards of the health plan performance.

• 14. Serve as a member of various managed care services committees such as Vendor Relations, BUMC and IS User Group Committees and other meetings as needed or requested.

• 15. Regularly review historical operating results and proactively identify and analyze potential revenue enhancement and cost-saving opportunities.

• 16. Take lead in planning, review, and execution of annual year-end audits.

• 17. Responsible for special projects assigned to him/her by the VP of Finance.

Organizational Accountabilities
Organizational Accountabilities (Managers)
Leadership Excellence

• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved

• Innovates through improvement of care and/or efficiency of operational processes.

• Dedicated to a standard of performance excellence and high quality

Collaboration

• Creates a safe environment that encourages brainstorming, creativity and “out-of-the-box” thinking

• Encourages a diverse group of people to communicate effectively and embrace creative thinking

• Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way

• Demonstrates listening and feedback skills

Leadership Skills

• Proactively assumes responsibility and accountability for results to include management of organizational change

• Empowers staff in ensuring a culture of transparency, fairness, respect and excellence

• Strategically aligns operational and tactical objectives to drive business results.

• Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication.

Supervisory Responsibilities
Blood Borne Pathogen Exposure
Protected Health Information Access Level
Working Environment
Physical Requirements
Travel Requirements