Healthcare Risk Management Jobs in Rochester, NY

Job Description:

Summary

The Director, Healthcare Economics is responsible for supervision of staff in the routine operation of the Healthcare Economics, Actuarial, and Analytics department. This position leads analysis of healthcare cost trend and medical cost, the financial forecasting and budgeting process, and program evaluation/ROI calculations for the health plan. The Director develops and presents financial and programmatic recommendations that protect the organization's financial integrity and improve healthcare affordability; information and recommendations provided must be sound and consistent to support the organization's mission, as well as target corporate cost management goals, new initiatives and other complex measures related to financial solvency. The incumbent plays an active role in the preparation and interpretation of data and related formulae. This role utilizes national and local information sources ranging from industry publications and consultants to analysis of internal data and works effectively with a wide variety of internal staff, external vendors, and regulators.

Essential Accountabilities

• Directs the development and design of analyses regarding medical utilization, cost and quality trends, and provider reimbursement models.

• Oversees the development, delivery, and maintenance of regular financial and clinical trend projections.

• Directs the ongoing evaluation of clinical and financial programs using both industry-standard and novel statistical methods.

• Delivers effective presentations of findings and recommendations, in oral and written format, to internal staff and management as well as external customers at various levels.

• Stays abreast of Health Care topics and trends regarding physician & facility reimbursement, quality reporting, healthcare reform, epidemiological trends, and alternate payment models.

• Advises leaders throughout the organization on the development and implementation of new programs, processes and procedures to achieve the organization's financial goals, with a focus towards continuous improvement.

• Forecasts health plan margin strategy requirements.

• Conducts trend-drivers analysis to support pricing, forecasting, opportunity identification, and program development.

• Systematically identifies and eliminates data biases to ensure all proposals support health equity.

• Designs, implements and maintains medical expense trend models including cross-functional collaboration and information sharing.

• Ensures and enforces efficient, scalable use of available software in the development of data sets and models.

• Develops and maintains appropriate level of technical expertise in the department.

• Identifies and manages departmental goals consistent with corporate objectives.

• Establishes individual annual performance goals for staff, guide staff in setting individual learning and development plans, assess individual performance, and determine merit, promotional and recognition salary increases and awards.

• Ensures efficient management of the department; promote continual process improvement.

• Mentors and develops staff to take leadership roles.

• Ensures that consistent policies and procedures are utilized across regions.

• Identifies emerging issues that impact corporate, divisional or departmental goals.

• 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

• Eight (8) years of relevant experience in a healthcare environment, of which at least three years of leadership experience required.

• Bachelor's degree in mathematics, statistics, actuarial science, healthcare informatics, or related field. In lieu of a degree, six (6) additional years of experience required

• Master's degree preferred.

• Demonstrated success in collaborating across divisions with technical, non-technical, and clinical stakeholders.

• Proven ability to analyze trends and translate data into actionable strategies.

• Comprehensive knowledge of financial planning and risk assessment.

• Advanced skills including proficiency in Microsoft Office, SAS and Cognos.

• Advanced verbal and written communication skills with the ability to present clear and concise information to all audiences.

• Ability to design and implement process improvements.

• Demonstrated advanced leadership and project management skills.

• Ability to translate technical concepts into business language.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.

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

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

Equal Opportunity Employment

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: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare 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.