Providence St. Joseph Health - Renton, WA
posted 6 months ago
Providence Health Plan is seeking a Manager of Actuarial Analytics to lead and oversee critical functions related to Medicaid and Medicare. This role is pivotal in ensuring the accuracy and effectiveness of capitation rate assumptions and methodologies, which are essential for the financial health of the organization. The Manager will be responsible for reviewing Medicaid capitation rate assumptions and providing oversight for financial and encounter data submissions that support Medicaid capitation rate setting. Additionally, the position requires providing expertise and consultation to support the Medicare bid process and pricing strategy, ensuring that the organization remains competitive and compliant with regulatory standards. The Manager will evaluate the financial performance of Medicaid and Medicare lines of business, maintaining a keen understanding of changing healthcare trends and actuarial regulations. This includes staying current on government regulations and guidance, as well as analytic techniques and methodologies that impact the organization. Building and maintaining relationships with other leaders across the organization, including Product, Finance, Regulatory, and Pharmacy, as well as external stakeholders such as CMS and provider groups, is a key aspect of this role. The Manager will also coach and set priorities for direct reports, fostering a collaborative and productive team environment. This position is fully remote, allowing for flexibility in work location, with the exception of certain states. The ideal candidate will have a strong background in healthcare actuarial practices, particularly in Medicare Advantage pricing and bid development, and will be adept at using SQL or other programming languages to analyze data effectively. The role requires a combination of technical expertise, project management skills, and the ability to lead and mentor a team.