Director Managed Care Finance – Sharp Corporate – Day Shift – Full Time page is loaded## Director Managed Care Finance – Sharp Corporate – Day Shift – Full Timelocations: San Diego, CAtime type: Full timeposted on: Posted Todayjob requisition id: JR204719Hours:Shift Start Time:VariableShift End Time:VariableAWS Hours Requirement:8/40 – 8 Hour ShiftAdditional Shift Information:Weekend Requirements:As NeededOn-Call Required:NoHourly Pay Range (Minimum – Midpoint – Maximum):$79.420 – $102.480 – $125.540The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. What You Will Do To oversee and direct the operations of the Managed Care Finance department. Responsible for the capitation revenue management and the development and provision of information to Financial Services, Contracts, Medical Groups, Hospitals, Claims Processing, Utilization Review and Patient Financial Services. To direct and oversee the operations of the Managed Care Finance department, including the development of financial analyses of capitation revenue, payor risk pools, health plan incentive programs, stop-loss activity, insured services, sub-capitated providers, and hospital sub-capitation arrangements. Provide personnel management for Managed Care Finance, including training and professional development. To develop and oversee the production of monthly medical group financial reports detailing such information as enrollment, bed days, encounters, risk-pool capitation payments and costs per member per month, incentive funds, etc., to allow for the effective monitoring of managed care contract financial results and physician practice patterns. To recommend and effectively communicate with, Senior Management, Contracts, Claims Administration, Financial Services, Patient Financial Services, Utilization Review, Medical Groups and Hospitals. Develops and maintains managed care financial policies and procedures. Develops and monitors departmental operating and capital budgets and assists management in the preparation and monitoring of System budgets. Participates on the Sharp Rees-Stealy Risk Pool Committee and various committees and task forces, as requested. Required Qualifications* Bachelor’s Degree in Accounting or Finance.* 5 Years Experience with a large medical group and hospital managed care accounting and financial analysis.* 4 Years management experience.Preferred Qualifications* Master’s Degree in Finance, Healthcare, or Financial Management.* Certified Public Accountant (CPA) – CA Board of Accountancy – PREFERREDEssential Functions* FINANCIAL PERFORMANCE Managed Care Finance department expenses and capital acquisitions are 98 0/6-100 0/0 of budget unless there is adequate justification approved in advance by the Vice President, Managed Care and the Senior Vice President, Finance, Chief Financial Officer. Adequate justification includes the addition of non-budgeted operating units, medical groups or financial responsibilities, etc. Standard represents Meets/Meets and Exceeds.* QUALITY AND CUSTOMER SERVICE Customer Service: Demonstrates effective customer relations by: consistently communicating with management, physicians, the Sharp Rees-Stealy Management, SCMG Management and other department members, Chief Financial Officers of the Hospitals, other affiliated physician groups and other Sharp employees in a pleasant, professional and effective manner; responding appropriately to needs, preferences and dissatisfactions expressed by customers within a time period appropriate to the request; maintaining confidentiality; ensuring effective, customer-focused operations of Managed Care Finance; providing effective consultation, development of reporting and support services to, and effectively communicating with, Senior Management, Sharp Rees-Stealy Management, Chief Financial Officers of each Hospital, Contracts, Claims Administration, Financial Services, Patient Financial Services, Utilization Review, Medical Groups and Hospitals to recommend strategic and operational planning and facilitate achievement of organizational goals; preparation and monitoring of unit budgets; development and implementation of the analysis and interpreting managed care financial trends and variances requiring Senior Management’s attention; identifies and produces for Senior Management other financial reports and analyses. Measure – Customer Satisfaction Survey to be distributed to customers, mutually selected by the incumbent and the Vice President, Managed Care and distributed one month prior to the annual review date. Effectiveness – Ensures optimum performance of the Director, Managed Care Finance function by: overseeing that health plan capitation payments received are in accordance with respective contract provisions based on enrollment/eligibility information received from the health plan; oversee the proper accounting for full-risk and shared risk capitation pools, including SDHA and medical group incentive programs, and reporting pertinent information to Senior Management, Operations Management, SDHA Management and Medical Groups; overseeing that procedures are in place such that health plan incentives are properly received; overseeing the proper submittance of and accounting for stop-loss premium payments and recoveries; overseeing that procedures are in place in order to properly receive payments for insured services; overseeing the proper accounting for sub-capitation payments in accordance with respective contract positions based on enrollment/eligibility information included in the managed care system; overseeing the proper accounting for hospital capitation revenue and hospital sub-capitation receipts in accordance with respective contract positions; overseeing that risk-pool audit adjustments proposed by the external auditors have no effect on net income, excluding items based on estimation and judgment when such items were discussed with and agreed to by the Vice President, Managed Care and Senior Vice President, Finance, Chief Financial Officer; overseeing that 90% of Management Letter comments are satisfactorily addressed for responsible areas; keeping abreast of current trends and practices in managed care financial reporting; ensuring that responsibilities of Managed Care Finance are completed in a safe, cost-effective manner; effectively using and planning personal leave time; demonstrating ability to effectively direct Managed Care Finance operations by insuring that no ‘surprises’ occur; sharing available resources and information with others; accepting interpersonal differences, respecting others’ values and opinions and promoting cooperation; effectively prioritizing workload and the workload of subordinates to meet required deadlines and setting work goals and objectives in consultation with the Vice President, Managed Care; pre-planning to allow adequate time for task completion and to identify needs/problems before starting the task; initiating follow-through when necessary; effectively trouble-shoot potential and actual problems; offering ongoing training and consulting to direct reports and customers. Measure – Standard represents Meets/Meets and Exceeds. Level of effectiveness as determined by the Vice President, Managed Care through dealings with the Director and through customer feedback results in higher standard. Lack of significant Management Letter comments, audit adjustments or “surprises” results
#J-18808-Ljbffr