Decision Support Specialist jobs in Orange, CA

Job Description
Department(s): Financial Analysis
Reports to: Director Financial Analysis
FLSA status: Non-Exempt
Salary Grade: O - $105,000 - $163,900


About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About the Position

The Principal Financial Analyst (Decision Support) will be responsible for providing highly complex analysis, guidance and expert knowledge on health care finance for various departments within CalOptima Health. The incumbent is a sought-out expert and company-wide resource on matters of health care finance. Working independently, the incumbent will lead complex large-scale analytical initiatives, develop report suites and financial models used to forecast medical cost trends. The incumbent will provide expertise for provider contract negotiations, assess actuarial rate development studies, participate in annual budgeting functions, leads ad-hoc teams and serve as a subject matter expert to staff and other consultants within the department. The incumbent will evaluate high visibility complex issues, perform detailed analysis and communicate well reasoned, thorough solutions to all levels of management within CalOptima Health. The incumbent will work with large amounts of claims, enrollment and provider data.


Duties & 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.

Experience & Education:

• Bachelor's degree in Business Administration, Finance, Economics, Actuarial Sciences or related field required.
• 8 years of experience working with health care finance reporting and analytics required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• 7 years of analytical experience working with Medi-Cal and/or Medicare payer information.
• Experience with risk adjustment concepts and familiarity with Hierarchical Condition Categories (HCC) and Chronic Illness and Disability Payment System (CDPS) models.
• Experience with DHCS rate development and/or Medicare Advantage bid process.

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employee may be required to move about the organization and to travel to offsite locations. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case while traveling, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health 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 Health 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.

Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4282

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