PHSO Health Actuary

Overview:

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California 

***This position is work from home within the Pacific or Mountain time zones.

Position Summary:

The Population Health Services Organization (PHSO) Health Actuary is responsible for post-negotiation capitation and value-based agreement analytics including routine forecasting and monitoring activities that advance CommonSpirit Health’s strategy to transform care delivery through value based care.

Working in partnership with CommonSpirit Payer Strategy and Relationships - Analytics and Innovation this role ensures successful implementation of risk/value-based agreement pricing strategies assists in compiling opportunity/risk assessments monitors financial performance maintains risk profiles assists in the development of actuarial projections and monitors risk contract profitability. As requested this role will assist Payer Strategy & Relationships leadership in creating innovative and transformative market and payer strategies that accelerate our transition to value-based agreements that drive the future of CommonSpirit Health by optimizing revenue and increasing the number of people served.
The PHSO Health Actuary is a key member of the CommonSpirit Population Health/PHSO team and will make significant contributions to the performance and implementation of system and local strategy risk/value-based transformation successful risk product pricing strategies and achieving budget targets.

Responsibilities may include:
- Monitors and evaluates composition and management of value-based payment models and risk arrangements with commercial and government payers aligned with a value based strategy.
- Assists in the translation of value generated from CommonSpirit Health providers Clinically Integrated Networks/ACOs and population health management programs into value-based payer contracts and reimbursement models.
- As requested assists in the development of value-based payment model standards and guidelines and provides consultative support to Payer Strategy and Relationships and Payer Analytics leadership in negotiations in conjunction with national standards and guidelines.
- Monitors post-negotiation performance of capitation revenue and reinsurance premium payments for CommonSpirit Health capitated value-based payer agreements.
- Monitors post-negotiation performance of value-based payer programs across CommonSpirit Health agreements.
- Extracts aggregates and validates disparate data from multiple sources in support of quantitative analyses and operational financial and clinical reporting for value-based agreements with payers.
- Collaborates with the System Director Risk Analytics & Economics Population Health and Clinically Integrated Network/ACO Operations areas to advance the alignment and accountability model in order to maximize the value of CommonSpirit Health value-based payer contracts.
- Management of IBNR calculations and presentation of month end IBNR balances to our clients.

- Prepare monthly IBNR reserve estimates and document assumptions.
- Design and perform actuarial studies related to medical care costs and trends.
- Research and develop reports/analysis to review value base/share risk contract financial performance and effectively communicate results to stakeholder management.

Minimum Qualifications:

- Minimum of five (5) years’ experience in large healthcare organizations and/or integrated healthcare delivery systems AND Minimum of two (2) years’ strategic management of healthcare pricing, contract negotiation, and healthcare economics in a complex, national or multi- regional healthcare system or health insurance environment.

- Bachelor's degree in mathematics statistics or a related field.
- Knowledge of value-based arrangements, ACO and population health analytics required.
- Proficient in Excel and SQL.
- Strong understanding of actuarial principles.
- Excellent communication and presentation skills.

- Ability to work independently and as part of a team.

Preferred Qualifications:

- Previous IBNR (Incurred But Not Reported) experience strongly preferred.

- Strong problem solving skills using sound, inclusive reasoning and judgment strongly preferred.

- Strong critical thinking skills strongly preferred.

- Cost of Healthcare forecasting and Reserve valuation experience preferred.
- Masters degree preferred.
- Fellow Society of Actuaries (FSA) preferred