Director, Financial Planning and Risk Revenue

Are you excited to step into a complex world that requires a blend of mind, heart and flexibility? We at CareOregon have been strengthening communities since 1994 by making health care work for everyone. As a nonprofit health plan largely focused on Oregon’s Medicaid population, we find fulfillment in supporting the underserved.

General Statement of Duties

This position is responsible for the execution of financial planning, rate setting, revenue optimization, and financial claims analysis for the organization. The majority of time is focused on business group oversight, with secondary time on enterprise-wide engagement. Primary duties include technical and operational leadership and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans for the Finance, as well as the broader organization.

Essential Position Functions

Technical Leadership

Financial Planning and Analysis

Provides management with forecasts and other reports to assist in decision making and strategic planning.
Ensures the successful execution of the company-wide budgeting process.
Oversees the preparation of financial proformas for new projects, programs and businesses.
Leads the on-going development of the Axiom software to ensure it meets the business’ needs.
Oversees the development of other financial modeling to support the business needs.
Identifies and helps implement opportunities for expense management or reductions.
Provides staff with ongoing understanding of the strategic and operational direction of the company.

Risk Revenue Optimization

Provides direction to risk score improvement efforts, sets goals and regularly monitors performance.
Leads the risk score optimization strategy development for Medicare and Medicaid.
Works with Network and Clinical Services to develop and implement risk score strategies.

Rate Setting

Provides direction for rate development work.
Oversees the OHP rate development process to ensure fair and optimal OHP rates.
Works with Health Share, the Oregon Health Authority, and actuaries as needed.
Provides financial oversight of the preparation of the Medicare bids.

Claims Analysis

Leads staff in performing claims analysis to determine cost drivers and opportunities for savings.
Participates in the Cost & Utilization workgroups
Collaborates with internal actuaries to analyze claims, identify cost savings opportunities and evaluate contracts and programs.
Serves as an expert on claims and billing issues to help identify and anticipate problems timely.
Works with the Internal Audit department to identify fraud, waste and abuse.

Strategic/Operational Planning

Participates in the development of vision, goals, and strategic plans.
Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.
Develops initiatives and programs, including cost savings and revenue optimization programs.
Provides input into the strategic plans with the Finance Director.
Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

Recommends budget updates 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; makes decisions on exceptions.

Relationship Management

Leads effective communications 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 CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.

Management and Leadership

Directs team(s) and establishes team and management goals.
Provides team members with ongoing understanding of business unit plans and expectations.
Performs employment functions in collaboration with Human Resources, including staffing, recruitment, performance management, professional development, and termination.
Coaches, motivates, and recognizes staff.
Creates opportunities for professional development.
Leads the development of performance goals, measurement, and evaluation of results.
Ensures participation in required training initiatives and organizational activities, as well as adherence to external regulations and internal policies.
Drives a culture of success in alignment with the organizational mission, vision, and values.

Essential Department and Organizational Functions
Supports and operates in alignment with the organization’s core values.
Strives to meet work goals that contribute to departmental and organizational goals.
Adheres to organizational standards, policies and procedures, as well as compliance requirements.
Performs other duties as assigned.

Knowledge, skills and abilities required

Understanding of Medicaid and Medicare programs
Understanding of CMS and OHP risk scoring methodologies
Understanding of healthcare claims and billing practices
Understanding of GAAP and statutory accounting practices
Strong people management and motivational skills to coach, teach and mentor a team
Proficient in all MS Office applications, including Excel, Word and PowerPoint
Strong understanding of data analysis methodologies
Excellent interpersonal, written and verbal communications skills
Ability to speak to all audiences, especially communication of technical matters to non-technical audiences
Ability to deliver work product appropriate for executive leadership and the Board
Ability to work in an environment with diverse individuals and groups
Ability to meet deadlines, manage multiple tasks and effectively prioritize work
Ability to adapt to change, delays, and unexpected events in the work environment

Physical Skills and Abilities
Lifting/Carrying up to 0 Pounds

Pushing/Pulling up to 0 Pounds

Pinching/Retrieving Small Objects

Crouching/Crawling

Reaching

Climbing Stairs

Repetitive Finger/Wrist/Elbow/

Shoulder/Neck Movement

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

Standing

Walking

Sitting

Bending

Seeing

Reading

Hearing

Speaking Clearly

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

More than 6 hours/day

3-6 hours/day

3-6 hours/day

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

Minimum 10 years’ related work experience, including 5 years in a managerial position and 5 years in health care or insurance.
Bachelor’s degree in accounting, business or related field
Preferred

Experience specific to Medicaid and Medicare plans

Working Conditions

Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

☐ Other_________________________________________

Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Position Description »