Remote Utilization Management Jobs in Portland, OR

Description

PeaceHealth is seeking a Remote (must reside in OR, WA or AK) Sr Actuarial Analyst Value Based Care for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $48.52 – $72.78. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Job Summary

The Value Based Care (VBC) Senior Actuarial Analyst will support the model design, data mining and manipulation, statistical programming of clinical and financial claims data for our Value Based Care and Population Health programs. This role combines statistical analysis, predictive modeling and financial forecasting, data mining and construct modeling to generate actionable insights that improve clinical outcomes and financial performance across value-based Medicare, Medicaid and commercial lines of business. The ideal candidate brings deep SQL and/or python expertise, strong value-based care and insurance claims data fluency, and the ability to translate complex findings into clear and meaningful insights.

Essential Functions

• Develops analytic models independently utilizing member claims, financial and clinical data to effectively answer strategic questions that drive the formation of initiatives and improvement of clinical outcomes and total cost of care.

• Leverages methodologies to quantify various impacts on spend such as health cost waste opportunities, care management return on investment, clinical quality or HEDIS metric impacts, behavioral health opportunities, pharmacy opportunities, and the like.

• Performs data mining and analysis that impacts benefit design, care delivery, and population health strategy

• Executes ad hoc analysis prioritized by VBC program leaders using SQL and/or Python programming

• Develops analytic methods to monitor and improve performance risks associated with value-based arrangements including but not limited to MSSP, ACO REACH, ACO LEAD, TEAM, CJRX, AHEAD, ACCESS and Medicare Advantage.

• Prepares annual revenue and claims forecasts, summary exhibits, and payer-specific utilization data for monitoring, improvement, and negotiations

• Calculates and validates revenue and HCC risk scores; support associated forecasting and reconciliation processes

• Drafts written reports and excel or PowerPoint based exhibits

• Communicates results and data in a meaningful, accessible way to stakeholders through graphs, presentations, and other performance tools

• Maintains clear documentation for all analytic processes, datasets, and methodologies

• Resolves and/or escalates issues to leadership in a effective way and timely manner

• Maintains knowledge of concurrent healthcare economic trends and advises on possible changes when market would dictate

• Performs other duties as assigned.

Qualifications

Education

• Bachelor's Degree Required: Math or

• Bachelor's Degree Required: Finance or

• Bachelor's Degree Required: Statistics Actuarial Science or Related field or equivalent combination of education and experience and

• Required: Actuarial exam track with two or more actuarial exams passed on the Society of Actuaries exam pathway toward Associateship (ASA) or Fellowship (FSA) designation and

• Master's Degree Preferred: or Master’s or PhD in related fields, CPA, MBA, Associate of the Society of Actuaries (SOA) designation such as ASA or FSA

Experience

• Minimum of 5 years Required: Advanced SQL and Python skills, including querying enrollment, provider, medical and pharmacy claims and experience with risk score calculations

• Required: Proficiency in value-based care analytics topics such as Medicare/Medicaid programs, Medicare Advantage, CMS CMMI, ACO REACH, Medicare Shared Savings Program (MSSP), Advanced Payment Models, the NPPES NPI registry and VBC modeling

Credentials

• Preferred: EPIC Certification EPIC Cogito

• Preferred: Certified Public Accountant

Skills

• Strong analytical, organizational and people skills. (Required)

• Enthusiasm for producing high-quality, professional work with accuracy and integrity (Required)

• Intellectual curiosity about business processes and claims data completeness (Required)

• Strong critical thinking, technical, and analytical acumen (Required)

• Clear, proactive communicator who articulates questions and ideas (Preferred)

• Proficient in use of MS Office applications (Word, Excel, Outlook, PowerPoint). (Required)

• Understanding of HIPAA rules and regulations. (Preferred)

• Ability to work both independently and interdependently with staff and team members with limited supervision. (Required)

• Excellent problem solving and critical thinking skills. (Required)

• Proactive and assertive conflict resolution skills (Required)

• Strong understanding of risk adjustment, HCC scoring and revenue forecasting methodologies (Required)

• Demonstrated ability to work independently, drive projects forward and deliver high quality work in a deadline driven environment (Preferred)

• Proven ability to present technical concepts clearly to non-technical audiences (Required)

• Experience in finance or healthcare industry settings (Required)

• Experience building actuarial models in SQL or python (Preferred)

• Experience with data visualization platforms such as Tableau, Microsoft Power BI, Fabric or similar tools. (Preferred)

Department / Location Specific Notes

Remote work within PeaceHealth approved locations with occasional travel (<5%)

Working Conditions

Lifting

• Consistently operates computer and other office equipment.

• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

• Sedentary work.

Environmental Conditions

• Predominantly operates in an office environment.

Mental/Visual

• Ability to communicate and exchange accurate information.

• The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.