Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving Hawai`i’s low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii’s third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.

The Culture:

AlohaCare employees have a passion for helping Hawai`i’s most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Opportunity:

The Senior Director of Financial Planning & Analysis is responsible to directly support the overall financial success of the organization by directing AlohaCare’s strategic financial planning and analysis activities. This role requires a mix of actuarial services, financial reporting, financial analytics, medical economics analytics, and project management skills leading to actionable budgeting, forecasting, and analysis of financial and operating results, as well as other routine and ad hoc retrospective and prospective financial, actuarial, and operational analysis and support. Position reports to the Chief Financial Officer.

Primary Duties and Responsibilities:

Leadership and Staff Development

• Responsible for hiring, leadership, coaching, training, and development of staff reporting to this position.

Actuarial Activities

• Directs actuarial operations for Medicaid and Medicare, including IBNR, claim adjustment expense, premium deficiency reserves, risk adjustment, and Annual Statement of Actuarial Opinion certification.
• Oversees and manages work performed by internal and external consulting actuaries.
• Supports the CFO in strategy and negotiations with MedQuest for annual rate development.

Cost of Care Committee and Medical Economics Workgroup

• Serves as the Finance Department lead for the internal Cost of Care Committee and Medical Economics Workgroup.
• Coordinates Medical Economics analysis, monthly meetings, and implements corrective action plans with the Cost of Care Committee members.

Budgeting and Forecasting

• Directs development of the annual operating budget for CFO approval, with specific emphasis on membership, revenues, and medical expenses.
• Develops the medical expense budget at an actionable, detailed level including by product, by island, by medical category, and supported by average unit cost and utilization measures.
• Includes coordination of the administrative budget developed by the Director of Financial Operations as it flows into the overall operating budget.
• Oversees monthly financial forecasting and monitors corrective actions' effectiveness.

Monthly Reporting

• Supports FP&A Team in development of effective and insightful monthly financial reporting packages at the direction of the CFO.
• Communicates associated analytical findings, conclusions, and recommendations to executive leadership.
• Oversees capitation reconciliations of revenues and provider pass-through payments.

Cost Analysis

• Directs performance of comprehensive and detailed cost of care analysis.
• Directs preparation of provider reimbursement analysis in support of network management and contracting activities.
• Directs preparation of ongoing provider risk pool analyses and statements.
• Directs development of quarterly ‘Run Rate’ analytical reports.

Risk Adjustment and Sharing

• Directs development and implementation of Risk Adjustment methodologies, and associated application to provider risk share arrangements.

• Oversees the development, negotiation, and finalization of contractual risk corridor programs with MED-Quest, subject to CFO approval.

• Provides comprehensive analysis and leads negotiations for the organization’s reinsurance program for CFO approval.

Medicaid, Medicare, and Regulatory Reporting

• Develops and maintains collegial and productive professional working relations with MED-Quest financial regulators.
• Leads and coordinates the Medicare annual bid process.
• Supports preparation of external regulatory financial and operating reports.

• Directs preparation of supporting schedules and analysis for annual financial, actuarial, and regulatory audits.
• Supports preparation of Risk Based Capital (RBC), statutory required capital reserves, and regulatory performance bonds calculations.

Internal Reporting

• Directs preparation and communication of internal financial and operating analytical reports.
• Establishes and maintains strong communications and relationships with internal executive team.
• Is the business owner of financial analytical software tools for Finance, Medical Economics, and Departmental Directors.

Hoc Analysis

• Performs other ad hoc actuarial and financial analysis, as assigned.

Other

• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality.

Requirements:

• Bachelor’s Degree with emphasis in mathematics, statistics, public health, health sciences, data analysis, accounting, finance, business, or health care administration or equivalent combination of education and experience.
• Minimum of 8 years of professional work experience with demonstrated ability to perform the duties required for the position.
• Minimum of 7 years of experience managing and developing a team.
• Developed leadership and coaching skills and executive level strategic thinking abilities.
• Budgeting and forecasting experience.
• Experience with managed health care actuarial policies and procedures.
• Experience with Medicaid and Medicare MCO rate setting policies and procedures.
• Experience using Access, SQL, and other statistical/analytical/reporting tools (Stata, SAS, SPSS, etc.).
• Knowledge of relational databases.
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Excellent interpersonal skills with the ability to communicate with all levels of the organization.
• Strong facilitation and leadership skills with ability to interact with various departments/ project teams.
• Excellent, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Ability to organize, coordinate and supervise large projects in a timely, creative and effective manner.
• Ability to solve problems, analyze, think critically, make good judgment and make fair decisions.
• Experience in project management, management reporting and analysis and excellent in building, maintaining and working with spreadsheets.
• Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Demonstrated strong skills in providing solutions and/or trouble shooting complex issues.
• Excellent leadership, communication, and analytical skills.
• Strong customer service skills and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• Advanced skills in Microsoft Programs: Word, Excel, Access, Outlook, PowerPoint, and Access.
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.

Preferred Requirements:

• Master’s Degree with emphasis in finance, business, health care administration, or related field or equivalent combination of education and experience.
• Minimum of 6 years of experience in managed health care insurance industry.
• Minimum of 5 years in key leadership roles.
• Knowledge of health research methodology, biostatistics, and medical terminology.

Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
• In office working environment.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.?

Salary Range: $145,000 - $155,000 annually

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.