Director Government Programs Finance

Job Description:

Summary:

The Director of Government Programs Finance is responsible for the management and coordination of assigned department to ensure accurate financial reporting/analysis necessary to support the Company’s strategic direction relative to the Safety Net Line of Business (LOB) and Medicare (LOB). This individual will provide analytical guidance to the Finance Department, the Government Program LOB leadership team and other senior leadership relative to the Company’s Government Programs. In addition, this individual will serve as the primary contact/liaison to other operating teams throughout the organization. This position also develops and provides integrated financial and actuarial models to support decision making of the Government Programs LOB leadership group. This role utilizes strategic thinking, management techniques and analytical know-how to define business requirements and ensure that functional deliverables are achieved. This individual may assume key project roles and/or manage tasks as required or assigned by senior management.

Essential Accountabilities:

• Participates in and reviews the premium rates set by Department of Health (DOH). Monitors the financial performance including product portfolio and dashboards.

• Participates in and reviews budgets and financial forecasts.

• Creates LOB drill down reporting and dashboards.

• Develops integrated solutions for community rated, experience rated and claim based billing pricing for evaluation of full Government Programs LOB.

• Evaluates membership forecast to achieve target and actual performance compared to budgeted and forecasted performance for Government Programs LOB.

• Participates in and reviews 5-year margin strategies and identifies levers to improve results.

• Plans and executes on corrective action strategies, drives business process improvement in all verticals to support Government Programs performance.

• Participates in the development of LOB strategies and provides related financial impact analysis.

• Determines key drivers and business insights for revenue, cost of healthcare and administrative expenses, knows which sensitivity tests are the most worthwhile, and understands and explains to others the reasons for variation from expectations.

• Supports and review analytical evaluation of pricing strategies and filings to ensure growth and execution of current goals and assess potential opportunities for improvement,

• Evaluates and pursues execution of business strategies including but not limited to risk adjustment, reinsurance and risk corridor.

• Interacts with all appropriate divisions to develop product strategies and price positioning.

• Reviews and analyze premiums based on membership demographic mix and medical severity.

• Coordinates and communicates with Executive Management on rate adequacy for safety Net products.

• Develops rate analysis for review with Department of Health as needed.

• Reviews, analyzes and interprets reviews medical loss ratio testing results.

• Prepares analysis to support growth opportunities for new geographic areas and government program product lines.

• Participates and provides input on the quarterly trend process.

• Acts as a key supporter of the LOB leadership team, as well as finance, driving analytical solutions to drive business decisions.

• Identifies, implements, and maintains procedures that will ensure compliance with state and federal regulations (where applicable).

• Drives work processes with a whole systems view, continuously evaluating and improving the sequence and content of work activities to optimize process effectiveness and integrity, with the objective of ensuring predictable and replicable success achieved through best practices.

• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct and Leading to the Lifetime Way values and beliefs.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.

• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.

• Regular and reliable attendance is expected and required.

• Performs other functions as assigned by management.

Minimum Qualifications:

• Ten (10) years of relevant experience in managed care with of which, at least five (5) years of management experience in a healthcare environment.

• Bachelor’s degree in accounting, mathematics, finance, business administration, or related field.

• Advanced credentials (ASA) or degree (MBA) preferred.

• Budget administration and pricing budget development knowledge and experience.

• Ability to turn data into information, information into insights.

• Advanced communication skills, written, oral and presentation.

• Ability to translate business requirements into technical solutions to influence pricing methodologies and applications.

• Statistical Analysis System (SAS) software experience.

• Expert analytical skills, execution-focused and results orientated.

• Strong leadership and management skills.

• Strong relationship with regulators and external lobbyists.

• Ensures professional development and education of assigned staff consistent with actuarial professional guidelines.

• High integrity and interpersonal skills. Ability to persuade, to negotiate, and to influence others. Maintains relationships with diverse constituencies inside and outside the Health Plan.

• Possesses a high sense of urgency and accountability.

• Ability to be decisive and to work cross-functionally with agility.

Physical Requirements:

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.

• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we’re on a mission to make our communities healthier, and we can’t do it without you. We know diversity helps fuel our mission and that’s why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees’ experiences, skills, and perspectives, we take action toward greater health equity.

We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade D4: Minimum $128,571 - Maximum $231,429

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. 

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.