This position will facilitate decision making by analyzing data, creating financial models, preparing reports, and completing other financial analyses as needed.
• Medical expense analysis, including production of cost and utilization reports.
• Develops medical expense, revenue, and enrollment projections to support the budget process.
• Researches, assesses, and develops advanced tools, models, reports, and approaches to increase accuracy and timeliness of data-driven work projects.
• Develops financial models and reports to support provider contract negotiations.
• Provides clinical and utilization analysis to assist Medical Management with improving outcomes and quality of care for CalOptima members.
• Other projects and duties as assigned.
Possesses the Ability To:
• Initiate and follow-through on projects with minimal supervision or guidance.
• Analyze performance and make recommendations based upon analysis.
• Develop and maintain effective working relationships with all levels of staff and health network partners.
• Work cooperatively and effectively on group projects.
• Demonstrate proficiency in spreadsheets, word processing, and database software programs.
• Problem-solve and analyze complex financial models.
• Communicate clearly and concisely, both verbally and in writing.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education:
• Bachelor's degree in Business Administration, Finance, Economics, Actuarial Sciences, or related field required.
• Experience in finance with an emphasis in financial analyses preferred.
• Experience in an Independent Physician Association (IPA), Hospital, or Health Plan setting preferred.
• Experience with managed health care programs preferred.
• Experience with Excel, SQL, Access, or Tableau preferred.
• Medical Expense trending methodologies.
• Principles and practices of managed health care industry and strategies, health care systems, capitated risk contracting, provider network structures and risk sharing arrangements.
• Techniques and methods in preparing forecasts, projections, and other health system reporting tools, including performance measures.
• Medi-Cal/Medicaid benefits, policies, and rates.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.