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CalOptima · 13 hours ago

Lead Decision Support (Principal Financial Analyst)

Orange, CA

Full-time

Hybrid

Senior Level, Lead/Staff

$110K/yr - $176K/yr

6+ years exp

CalOptima is a mission driven community-based organization that serves member health with excellence and dignity. They are seeking a Lead Decision Support (Principal Financial Analyst) to provide complex analysis and expert knowledge on healthcare finance, assist in provider contract negotiations, and lead financial modeling efforts to support the organization's goals.

GovernmentHealth CareNon Profit

Comp. & Benefits

Responsibilities

Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability

Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department

Shares expert knowledge, mentors, trains and serves as a lead for analytical staff

Serves as a subject matter expert in the following areas: Medi-Cal provider rate methodology, Medicare provider rate methodology, Department of Health Care Services (DHCS) revenue, Centers for Medicare & Medicaid Services-Medicare Advantage (CMS-MA) revenue, population health member cohort identification, industry standard approaches to health care cost service categorization and metrics

Forms and leads ad-hoc teams on key initiatives

Provides expertise and analyses around risk adjustment

Leads in the design, development, implementation and maintenance of report suites and dashboards for all levels of CalOptima Health management

Researches, assesses and develops advanced tools, models, reports and approaches to increase accuracy and timeliness of data-driven work projects

Develops medical expense, revenue and enrollment projections to support the budget process

Develops financial models and reports to support provider contract negotiations

Develops return on investment and business case analyses for program initiatives under consideration by management

Provides clinical and utilization analysis to assist Medical Management with improving outcomes and quality of care for CalOptima Health members

Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse

Completes other projects and duties as assigned

Qualification

Financial analysisProvider contract modelingMedi-Cal provider rate methodologyMedicare provider rate methodologyExcel proficiencyFinancial modelingTableau experienceAnalytical skillsProject managementCommunication skills

Required

Bachelor's degree in business administration, finance, economics, actuarial sciences or related field PLUS 6 years of financial analysis experience in managed care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying

3 years of experience in Provider Contract Modeling, Provider Rate Analysis, Provider Reimbursement Pricing and/or Managed Care Contracting in a health care setting required