![Southwestern Health Resources](https://secure.icbdr.com/MediaManagement/Y4/MG31TJ6LBP7ZTJQPPY4.jpg)
Senior Director Medical Economics and Actuary Services
1 week ago
Southwestern Health Resources (SWHR) is a patient-centered, clinically integrated network of 31 hospital locations and more than 7000 physicians and clinicians caring for more than 790,000 patients across 16 counties in North Texas. Blending the strengths of Texas Health Resources and the University of Texas Southwestern Medical Center, SWHR offers an unmatched ability to connect individuals with a full spectrum of nationally preeminent, clinical care. SWHR is the parent of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan that serves North Texas seniors.
At SWHR, we believe healthcare can be more integrated, accessible and affordable for all
Our purpose:
to build a better way to care, together
Our promise:
to simplify and empower care, for good
Work location:
Southwestern Health Resources Headquarters, Farmers Branch, TX.
Job Summary
The Sr.
Director is responsible for building and leading a team in assigned areas of expertise - actuarial modeling, financial and business development analytics, physician compensation, market insight.
This position is accountable for all Med Econ functions and initiatives, overseeing capability development and delivery to SWHR objectives.Position Duties
Provides the principal guidance across the organization to the senior leadership teams regarding the actuarial activities of both internal and external consulting actuaries to develop and utilization actuarial models and analyze healthcare cost and utilization data, complete actuarial calculations, and implement software solutions.
Develop continuous improvement procedures throughout Network Service analytics, including the development and production of KPIs, measurements and reporting for providers and internal senior leaders; work with Network Development for onboarding selection reporting, determine efficiency opportunities and computing impact efficiency dollars, implementation of specialty reporting, and other ad hoc to support Network Service strategies.
Represents SWHR as lead and coordinates interactions with all regulatory value-based contracting with governmental agencies such as Centers for Medicare and Medicaid Innovations and providing pivotal feedback for risks and concerns during model performance and process improvements opportunities.
Works collaboratively across all SWHR functional areas and external providers to support strategies for value-based activities such as Population Based Payments, SNF Waiver, Telehealth Expansion etc.
Responsible for establishment, on-going maintenance, and improvement of the submission and reporting processes and partnering with operations in the development of tools and strategies that facilitate successful enhancements, polices, and compliance of activities.
Support associated reporting, create and maintain policies and best practices, monitory industry trends involving physician compensation such as virtual bundles for specialists, and ancillary gain share arrangements etc.
Ensuring compensation models and practices are effective, timely enforced, and compliant and aligned with strategic objectives.Leverage data science and statistical analysis to support strategic oversight for SWHR's corporate key performance indicators.
Designing complex simulations to drive to the development of SWHR network efficiency goals given geographic and adequacy constraints of the network.
Builds executive and management dashboard to provide visibility and access to key metrics to define target for KPIs, track progress against targets.
Actuarial Analyses:
Assist in the development of Medicare Advantage bids for CNC.
Perform actuarial research, experience studies, and statistical analyses.
Develop and present actionable recommendations to leadership based on all analyses.
Perform actuarial analysis to assist provider contracting effort.
Calculate monthly IBNR.
Serve as SME for these activities and perform actuarial projects and other duties as assigned.
Strategy:
Provide strategic and financial advice when working with consulting actuaries to develop and utilize actuarial models, analyze healthcare cost and utilization data, complete actuarial calculations, and implement software solutions.
Manage high-level relationships with these key individuals to ensure the success to partnerships and business outcomes.
Develop and apply actuarial models to diverse client situations.
Build and lead a team in assigned areas of expertise - analytics, regulatory, physician compensation, market insight. Overseeing capability development and delivery to SWHR objectives.
Strategic consultant to operations, marketing, legal, finance, care coordination, coding, quality teams based on senior expertise on projections, regulatory, and value-based options for SWHR pivotal future planning
#LI-AZ1
Education
Bachelor's Degree in Data Science, Actuarial Science, Healthcare, Mathematics, or related field required
Experience
8 years Actuarial experience (4 of those years must be in healthcare). Must include supervisory/leadership experience, and experience in database applications required.
Licenses and Certifications
Credential as an Associate of the Society of Actuaries (ASA) required upon hire
Credential as Fellow of the Society of Actuaries (FSA) preferred upon hire
Skills
Must have knowledge and understanding of the operations of a captive insurance company.
Must have knowledge of all aspects of healthcare actuarial practice, including pricing, reserving, and forecasting.
Ability to prioritize and complete multiple projects and tasks.
Computer proficient, intermediate to advanced excel skills and proficiency with spreadsheets.
Ability to creatively solve problems.
Ability to organize information and draw logical conclusions.
Must have creative actuarial capabilities.
Good communication and interpersonal skills, and organizational talents.
Must have a high degree of self-motivation and the ability to contribute to an analytical team.
Why Southwestern Health Resources
As a Southwestern Health Resources you'll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
Let's move healthcare forward - together.
-
Actuarial Analyst I
1 month ago
Dallas, Texas, United States GAINSCO Full timeAre You Driven? We Are.We are a company of driven, enthusiastic, and determined people. We celebrate achievement and success. We foster innovation, determination, and recognition. Because of that, our employees feel recognized and rewarded for the contributions they make daily. At GAINSCO, it is our people that set us apart.If you are looking for a place...
-
Healthcare Financial/Actuarial Senior Associate
2 months ago
Dallas, Texas, United States Willis Towers Watson Full timeJob DescriptionCandidates from the following locations will be considered: Denver CO, Houston TX, Irvine CA, Los Angeles CA, San Francisco CA, Seattle WA, Tempe AZAs a Healthcare Financial/Actuarial Senior Associate you will be a key member of the Financial Actuarial & Analytics (FAA) Community of Expertise. You will substantially contribute to a wide...
-
Healthcare Financial/Actuarial Senior Associate
3 weeks ago
Dallas, Texas, United States Willis Towers Watson Full timeJob DescriptionCandidates from the following locations will be considered: Denver CO, Houston TX, Irvine CA, Los Angeles CA, San Francisco CA, Seattle WA, Tempe AZAs a Healthcare Financial/Actuarial Senior Associate you will be a key member of the Financial Actuarial & Analytics (FAA) Community of Expertise. You will substantially contribute to a wide...
-
Economic Development Sr Project Manager
12 hours ago
Dallas, Texas, United States Oncor Electric Delivery Full timeRequisition Number: ECONO005586SummaryThis senior position is responsible for directing specific economic development projects of all sizes and scopes that enable the growth of the Oncor system through the expansion and recruitment of business to the Company's service area to enhance and maximize the effective utilization of existing facilities as well as...
-
Health and Welfare Actuary
1 month ago
Dallas, Texas, United States Lockton, Inc. Full timeJob Summary: Lockton Dunning Benefits is currently seeking a Health and Welfare Actuary. This position will support the Health and Welfare clients of Lockton Dunning Benefits. The ideal candidate will demonstrate a high level of professionalism; possess the ability to work well in a fast-paced environment and the flexibility to easily adapt to changing...
-
Health and Welfare Actuary
3 weeks ago
Dallas, Texas, United States Lockton, Inc. Full timeJob Summary: Lockton Dunning Benefits is currently seeking a Health and Welfare Actuary. This position will support the Health and Welfare clients of Lockton Dunning Benefits. The ideal candidate will demonstrate a high level of professionalism; possess the ability to work well in a fast-paced environment and the flexibility to easily adapt to changing...
-
Dallas, Texas, United States Willis Towers Watson Full timeJob DescriptionSummaryAs a Financial, Actuarial, and Analytics (FAA) Regional Lead, you will contribute to the FAA delivery for your region within WTW North America. You are an H&B financial expert who will oversee teams in the delivery of complex quantitative analyses to clients across all segments, serving on the FAA leadership team to drive consistency...
-
Dallas, Texas, United States Willis Towers Watson Full timeJob DescriptionSummaryAs a Financial, Actuarial, and Analytics (FAA) Regional Lead, you will contribute to the FAA delivery for your region within WTW North America. You are an H&B financial expert who will oversee teams in the delivery of complex quantitative analyses to clients across all segments, serving on the FAA leadership team to drive consistency...
-
Director, Management Consulting
1 week ago
Dallas, Texas, United States MUFG Investor Services Full timeEOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. Description Title: Director, Management ConsultingLocation: Hybrid /...
-
Retirement Actuarial Technical Leader
2 months ago
Dallas, Texas, United States Willis Towers Watson Full timeJob DescriptionThe RoleIn this exciting role as a Technical Leader within the Actuarial Delivery Group (ADG), you will apply your technical and project management skills in the areas of retirement plan valuations, design, compliance, and risk and financial management for all types of retirement plans including defined benefit, defined contribution, and...
-
Retirement Actuarial Technical Leader
3 weeks ago
Dallas, Texas, United States WTW Full timeThe Role In this exciting role as a Technical Leader within the Actuarial Delivery Group (ADG), you will apply your technical and project management skills in the areas of retirement plan valuations, design, compliance, and risk and financial management for all types of retirement plans including defined benefit, defined contribution, and retiree medical....
-
Retirement Actuarial Technical Leader
2 months ago
Dallas, Texas, United States WTW Full timeThe Role In this exciting role as a Technical Leader within the Actuarial Delivery Group (ADG), you will apply your technical and project management skills in the areas of retirement plan valuations, design, compliance, and risk and financial management for all types of retirement plans including defined benefit, defined contribution, and retiree medical....
-
Retirement Actuarial Technical Leader
3 weeks ago
Dallas, Texas, United States Willis Towers Watson Full timeJob DescriptionThe RoleIn this exciting role as a Technical Leader within the Actuarial Delivery Group (ADG), you will apply your technical and project management skills in the areas of retirement plan valuations, design, compliance, and risk and financial management for all types of retirement plans including defined benefit, defined contribution, and...
-
Regional Director of Sales- Texas DFW
1 week ago
Dallas, Texas, United States Frontier Senior Living Full timeFrontier Senior Living, LLC is growing With over 100 communities established throughout the United States, we are excited to keep the momentum going. To support our continual growth, we are seeking a skilled Regional Director of Sales to join our fast-paced Regional team located in Texas- DFW and Surrounding Areas. This position offers an opportunity for...
-
Dallas, Texas, United States Alvarez and Marsal Full timeDescription PEPI - CFO Services Senior Director (Financial Reporting Advisory)OVERVIEW:A&M CFO Services work with private equity held portfolio companies and provide our clients with solutions to preserve and generate value for their businesses. Our goal is to improve transparency by providing accounting and financial reporting advice to clients on a wide...
-
Director/Senior Asset Manager
3 weeks ago
Dallas, Texas, United States Michael Page Full timeAbout Our Client Our Client is a growing real estate acquisitions and development investment firm who own and develop multifamily properties across the Southeast Region of the US. They invest in both core and value-add assets with a focus on multifamily, especially assets that require repositioning in secondary and tertiary markets. Job Description Newly...
-
Director/Senior Asset Manager
1 month ago
Dallas, Texas, United States Michael Page Full timeAbout Our Client Our Client is a growing real estate acquisitions and development investment firm who own and develop multifamily properties across the Southeast Region of the US. They invest in both core and value-add assets with a focus on multifamily, especially assets that require repositioning in secondary and tertiary markets. Job Description Newly...
-
Senior Compliance Analyst
1 week ago
Dallas, Texas, United States CornerStone Technology Talent Services Full timeSenior SOX Compliance Analyst Location:North Dallas AreaLOA:Full-Time on-site 5 days per week Job Summary:The Senior SOX Compliance Analyst will assist in managing the SOX Compliance program, reporting to the Director of SOX Compliance. Responsibilities include conducting the annual SOX risk assessment, maintaining SOX documentation, and ensuring the...
-
Director, Data Science
12 hours ago
Dallas, Texas, United States UPLAND CAPITAL GROUP INC Full timePrimary Function: Upland Capital Group, Inc. is an AM Best rated "A-" VIII specialty property/casualty insurer headquartered in Dallas, Texas. Through its wholly owned insurance carrier, Upland Specialty Insurance Company, the company markets, underwrites and services specialty insurance products in select markets to include excess transportation,...
-
Health Plan Sales Senior Director
3 weeks ago
Dallas, Texas, United States NTT DATA Services Full timeReq ID: NTT DATA Services strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.We are currently seeking a Health Plan Sales Senior Director (Remote) to join our team in Dallas, Texas (US-TX), United States (US).NTT DATA...