- Lead the review of Medicaid capitation rate assumptions and methodology
- Provide oversight to financial/encounter data submission in support of Medicaid capitation rate setting
- Provide expertise and consultation to support the Medicare bid process and pricing strategy
- Evaluate the financial performance for Medicaid/Medicare lines of business
- Maintain an understanding of the changing health care trends and actuarial regulations and how they impact the organization
- Remain current on government regulation and guidance as well as analytic techniques and methodologies, data sources
- Build and maintain relationships with other leaders across the organization including Product, Finance, Regulatory, Pharmacy, and outside the organization (CMS, provider groups)
- Coach and set priorities for direct reports
- Colorado
- Hawaii
- Massachusetts
- New York
- Ohio
- Pennsylvania
- Bachelor's Degree in Statistics, Computer Science, Mathematics, Social Science or another related field of study
- 5+ years of healthcare actuarial experience; Experience working with Medicare Advantage pricing and bid development
- Experience with writing queries in SQL or another programming language
- Demonstrated experience applying project management skills in data-related and financial analysis projects
- Master's Degree in Statistics, Computer Science, Mathematics, Social Science or another related field of study
- Fellow or Associate in the Society of Actuaries (FSA or ASA)
- Experience certifying the Medicare Advantage Bid
- Experience with Commercial, Medicare, and Medicaid revenue methodologies
- Demonstrated experience with managing professional staff who work independently on tasks and projects
-
Providence Portland, United States Full timeProvidence Health Plan caregivers are not simply valued – they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain ...
-
Senior Actuarial Analytics, Medicare Bid Remote
3 weeks ago
Providence Health & Service Portland, United StatesJob Description · Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to ...
-
Data Interoperability Coordinator
2 weeks ago
State of Oregon Portland, United StatesJob Description: · The program in Portland, Oregon has a fantastic career opportunity for a Data Interoperability Coordinator (Operations and Policy Analyst 3)to lead for the strategic development, coordination, management, delivery, and evaluation of data interoperability throug ...
-
RN - Utilization Management
1 week ago
Legacy Health Portland, United StatesRN - Utilization Management · US-OR- · Job ID: · Type: Part Time - Benefitted · Homebased EE Oregon · Overview · Relocation Assistance Available · The Legacy nursing philosophy focuses on patients and their families. Our nurses embody this philosophy in everything they do, as ad ...
-
Senior Financial Analyst
2 weeks ago
Northwest Permanente Portland, United StatesOverview: · The Senior Financial Analyst is responsible for financial and market analytics that support clinical provider contract negotiations and network development activities through analyses and reporting of critical information including utilization data. · The Senior Fina ...
-
Senior Risk Adjustment Analyst
5 days ago
PacificSource Administrators, Inc. Portland, United States**Position Overview:** The Senior Risk Adjustment (RA) Analyst assists in the accurate and comprehensive data submission to regulatory entities such as the Centers for Medicare & Medicaid Services (CMS) for all risk adjustable populations. This position leverages available tools ...
-
Medical Coding Educator
5 days ago
Cambia Health Solutions, Inc Portland, OR, United StatesRISK ADJUSTMENT PROVIDER EDUCATOR · Work from home within Oregon , Washington , Idaho or Utah (WA PREFERRED) · Join our to create a person-focused and economically sustainable health care system. · Every day, Cambia's dedicated team of Risk Adjustment Operations is living our m ...
-
Medicare Compliance Analyst II or III
3 weeks ago
Cambia Health Solutions Portland, United StatesCompliance Analyst II or III · Want to apply Read all the information about this position below, then hit the apply button. · Work Remotely from Oregon, Washington, Idaho or Utah · Primary Job Purpose · As a member of the Compliance team, the Compliance Analyst is responsible ...
-
Risk Adjustment Provider Educator
1 week ago
Cambia Health Solutions, Inc Portland, United States· RISK ADJUSTMENT PROVIDER EDUCATOR · Work from home within Oregon, Washington, Idaho or Utah (WA PREFERRED) · Build a career with purpose. Join our · Cause to create a person-focused and economically sustainable health care system. · Who We Are Looking For: · Every day, Cam ...
-
Risk Adjustment Provider Educator
1 week ago
Cambia Health Solutions, Inc Portland, OR, United StatesRISK ADJUSTMENT PROVIDER EDUCATOR · Work from home within Oregon , Washington , Idaho or Utah (WA PREFERRED) · Build a career with purpose. Join our to create a person-focused and economically sustainable health care system. · Who We Are Looking For: · Every day, Cam ...
-
Medicare Compliance Analyst II or III
5 days ago
Cambia Health Solutions Portland, United StatesCompliance Analyst II or III · Work Remotely from Oregon, Washington, Idaho or Utah · Primary Job Purpose · As a member of the Compliance team, the Compliance Analyst is responsible to deliver an effective compliance program. They design, implement, deliver, measure and refine ...
-
Actuary
4 weeks ago
CareOregon Portland, United States Full timeCandidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. · Job Title · Actuary · Exemption Status · Exempt · Department · Finance · Manager Title · Actuarial Services Manager · Direct Reports · n/a · Req ...
-
Contracts & Regulatory Specialist
1 day ago
Ardon Portland, United StatesJob Description · Job DescriptionAs we continue to grow, we are seeking a Contracts & Regulatory Specialist to join our award-winning specialty pharmacy team. · About Ardon HealthAt Ardon, we are passionate about our mission to inspire people and improve lives through the delive ...
-
Policy & Implementation Analyst
3 weeks ago
Cambia Health Solutions Portland, United StatesPolicy & Implementation Analyst · Telecommute Option - Must reside in ID, OR, UT or WA · WHO WE NEED · The Policy and Implementation Analyst uses Medical coding knowledge and experience and evaluates, recommends and implements clinical editing solutions to assure accurate outc ...
-
Risk Adjustment Provider Educator
6 days ago
Cambia Health Solutions Portland, United StatesRISK ADJUSTMENT PROVIDER EDUCATOR · Work from home within Oregon, Washington, Idaho or Utah (WA PREFERRED) · Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. · Who We Are Looking For: · Every day, Cambia ...
-
Financial Planning
2 weeks ago
Kaiser Permanente Portland, United StatesMust reside in the state of Oregon or Clark County and Cowlitz County, WA · The Financial Analyst V is a financial lead in contract negotiations to construct analytics using Medicare payment and reimbursement methodologies by utilizing claims data. They will calculate financial i ...
-
Healthcare Data Analyst II
2 weeks ago
PacificSource Portland, United StatesLooking for a way to make an impact and help people? · Join PacificSource and help our members access quality, affordable care · PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a prot ...
-
Actuarial Analyst I
2 weeks ago
CareOregon Portland, United StatesCandidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. · Position Title: Actuarial Analyst I · Department: Finance · Title of Manager: Actuarial Services Manager · Supervises: Non-supervisory positi ...
-
Health Policy and Analytics Director
3 weeks ago
State of Oregon Portland, United StatesInitial Posting Date: · 05/02/2024 · Application Deadline: · 05/23/2024 · Agency: · Oregon Health Authority · Salary Range: · $10,674 - $16,520 · Position Type: · Employee · Position Title: · Health Policy and Analytics Director (Health and Policy Program Administrator 3) · Job D ...
-
Quality Improvement Analyst II
3 weeks ago
CareOregon Portland, United StatesCandidates hired for remote positions must reside in Oregon or Washington. · Job Title · Quality Improvement Analyst II · Exemption Status · Exempt · Department · Informatics & Evaluation · Manager Title · Quality Metrics Manager · Direct Reports · n/a · Requisition # ...
Manager Actuarial Analytics, Medicare - Portland, United States - Providence Health & Services
Description
Job DescriptionProvidence Health Plan caregivers are not simply valued - they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Providence Health Plan is calling a Manager Actuarial Analytics who will:
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Us
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.