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Senior Director Medical Economics and Actuary Services

4 months ago

Dallas, Texas, United States Southwestern Health Resources Full time
Senior Director Medical Economics and Actuary Services

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.

Work with direct reports to enhance existing capabilities, improve processes and drive accountability across functions.


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.

Responsible for the strategic design and administration of the physician compensation programs at Southwestern Health Resources. Develops, implements, and administers physician compensation strategies, models, and programs. Oversees and implements controls and procedures across multiple departments to ensure timely reporting, accurate and compliant reporting and payouts. Establish compensation plans and incentives, direct the preparation of compensation models, determine fair market value and commercial reasonable.

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.

Communicate regularly with financial directors and internal/external stakeholders at all levels (including executive heads).
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.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Let's move healthcare forward - together.