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System Director Risk Analytics

Company: CommonSpirit Health
Location: Rancho Cordova
Posted on: January 11, 2022

Job Description:

Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities
- Job Summary: - The System Director, Risk Analytics & Economics is responsible for value-based agreement analytics, pricing and forecasting activities that advance CommonSpirit Health's strategy to transform care delivery and promote healthy populations. This role oversees the activities to develop risk/value-based agreement pricing strategies, compile opportunity/risk assessments, monitor financial performance, develop risk profiles, perform actuarial projections, and measure risk contract profitability. This role also assists 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 System Director, Risk Analytics & Economics is a key member of the Payer Strategy & Relationships - Analytics & Innovation leadership team, and will make significant contributions to the development and implementation of system and local strategy, risk/value-based transformation, successful risk product pricing strategies, achievement of employee engagement goals, and achieving budget targets. - Essential Key Job Responsibilities: -

  • Evaluates the composition, pricing, and management of value-based payment models and risk arrangements with commercial and government payers in support of aligned strategy.
  • Translates value generated from CommonSpirit Health providers, Clinically Integrated Networks/ACOs, and population health management programs into value-based payer contracts and reimbursement models.
  • Develops value-based payment model standards and guidelines and provides consultative support to Payer Strategy and Relationships and Payer Analytics leadership in the negotiation of both commercial and government value-based/risk arrangements in conjunction with national standards and guidelines.
  • Models hospital and professional capitation revenue and reinsurance premium payments for CommonSpirit Health capitated value-based payer agreements.
  • Supports pricing strategy development for risk/reinsurance products offered directly to employers.
  • 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 System and Division Finance, Legal, Physician Enterprise, 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. A compensation range of $125,000 -- $160,000 -is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law. - - While you're busy impacting the healthcare industry, we'll take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more! - #missioncritical #LI-DH
    Qualifications
    Minimum Qualifications: -
    • Bachelor's degree - Master's degree preferred
    • Minimum of eight (8) years' experience in large healthcare organizations and/or integrated healthcare delivery systems
    • Minimum of five (5) years' strategic management of healthcare pricing, contract negotiation, and healthcare economics in a complex, national or multi-regional healthcare system or health insurance environment Certifications Fellow, Society of Actuaries (FSA) preferred - Required Minimum Knowledge, Skills, Abilities and Training
      • Demonstrated success in leading, implementing, and managing financial performance of risk/value-based payer contracts
      • High degree of advanced analytical and problem-solving skills with specific application to hospital, medical and actuarial data
      • Advanced actuarial and capitation management skills with knowledge of actuarial analysis and risk evaluation methodologies necessary for designing value-based reimbursement models, calculating and evaluation reimbursement rates, and forecasting effect on revenues and expenses -

Keywords: CommonSpirit Health, Rancho Cordova , System Director Risk Analytics, Executive , Rancho Cordova, California

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