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Director of Finance and Strategy, MassHealth Product

4 months ago

Boston, United States BMC HealthNet Plan Full time
Job Description

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Director of Finance and Strategy, MassHealth Product will be the Finance program lead for the WellSense ACO and MCO programs under the Massachusetts Medicaid product known as MassHealth. WellSense's MassHealth enrollment includes >500k lives across 8 different ACOs and 1 MCO throughout Massachusetts. With this portfolio, WellSense is the largest health plan in the MassHealth program and our enrollment covers nearly 40% of MassHealth lives statewide. The MassHealth product is core to our health system mission of serving underserved populations across Massachusetts.

Our Investment in You:
  • Full-time remote work
  • Competitive salaries
  • Excellent benefits

Under the direction of the Finance team at WellSense and in close partnership with the Population Health Services team at BMCHS, the Director will lead the finance arm of ACO performance and strategy. ACO performance measurement cuts across a number of key areas - medical expense management efforts (BH services, transitions of care services, and site of care optimization, to name a few), quality program performance, risk adjustment, and health equity. In designing and implementing strategy and programs against these performance levers, teams of clinicians, administrators, ACO provider partners, and others come together to collaboratively innovate and build programs that address the needs of our MassHealth members. The Director will be a key player in linking programs back to financial performance, scoping financial impact for new ventures and opportunities, measuring and reporting on progress and outcomes, and liaising and advocating with partners at the state on finance and program policy and design.

The role will oversee the people, processes, and systems that deliver timely and accurate reporting. In addition, this leader will be the face of the WellSense Finance Team with ACO partners - explaining performance, uncovering questions and opportunities, and helping ACOs leverage financial reporting and measurement to inform local strategies and program planning. The Director is responsible for the financial performance measurement and reporting for the MassHealth product, so the director must maintain a broad understanding of the MassHealth program design in order to identify and explain drivers of current financial performance and advocate for strategic program changes with the state or ACO partners to maximize results. This role requires comfort working in a matrixed environment, with significant interactions with the health plan executive team, external ACO executive staff and leaders at the state.

Key Functions/Responsibilities:
  • Oversee preparation, distribution and presentation of MassHealth financial reports to ACO partners and state agencies, incorporating latest market and risk adjustment simulations available from the state.
  • Work closely and regularly with the population health team to identify custom initiatives and strategies to maximize financial performance at each ACO given their unique relative performance.
  • Work closely with the financial planning team to incorporate financial projections in reported financials and understand drivers of relative performance differences across our ACOs.
  • Coordinate any custom incentive accruals with the accounting / controllers team as needed.
  • Work closely with the system analytics team to help identify drivers of financial performance and performance improvement opportunities for each ACO.
  • Work closely with the trend, risk adjustment and actuarial teams as needed to understand drivers of medical trend and changes in relative risk scores for each ACO.
  • Analyze competitor financial performance to identify opportunities for performance improvement.
  • Support regulatory reporting for other product lines as needed.
  • Synthesize strategic decision making information to facilitate strategy recommendations to the executive team and the board.


Supervision Exercised:
  • Will direct 2 - 4 staff members

Supervision Received:
  • General supervision is received weekly.

Qualifications:

Education:
  • Bachelor's Degree in Mathematics, Actuarial Science, Finance, Economics or related field required.
  • Proficiency working with MS Office software.•
  • Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) preferred.

Experience:
  • A minimum of five years of progressively responsible experience in healthcare consulting or other areas of healthcare with a demonstrated ability to drive performance.

Certification or Conditions of Employment:
  • Pre-employment background check

Competencies, Skills, and Attributes:
  • Time management skills to meet deadlines, multi-task, and prioritize projects under specific time constraints. Project management skills a plus.
  • Ability to work collaboratively with a variety of business partners.
  • Strong communications skills, both verbal and written, are required.
  • General understanding of Medicaid risk adjustment models preferred.
  • Strong team player
  • Strong understanding of healthcare delivery system
  • Superior executive presence - able to comfortably present to Executive level audience.
  • Must be able to conceptualize and envision the impact of change and propose ways of mitigating financial impact.

Working Conditions and Physical Effort:
  • This position is remote.
  • Occasional onsite staff meetings may occur.
  • No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees