Responsible for the management of CalOptima’s overall financial operations including financial planning and analysis, finance and accounting, purchasing, investment management, and monitoring of health network financial compliance. The incumbent is responsible for developing and monitoring performance against an annual budget of 3.5 billion dollars. Establishes financial policies and procedures as appropriate, provides financial strategic management, and manages the financial assets of CalOptima to the optimum benefit of members, providers and taxpayers.
- Establishes policies that will ensure the fiscal integrity of CalOptima.
- Oversees the preparation of CalOptima’s annual budget, presents it to the Board of Directors; ensures monthly compliance and/or appropriate documentation and explanation of variances from budget.
- Manages cash flows and invests surplus funds to CalOptima’s best advantage and in accordance with CalOptima’s Annual Investment Policy.
- Monitors and directs financial plans, including actuarial projections of capitation rates received, paid, and incurred, but not reported ("IBNR") liabilities associated with medical claims.
- Participates in formulating, receiving and approving CalOptima’s plans and objectives.
- Prepares monthly financial reports for CalOptima’s Board of Directors and the Finance Committee.
- Serves as a member of CalOptima’s Investment Advisory Committee ("IAC").
- Participates in the strategic planning process.
- Establishes and maintains bank accounts, financial controls, and business relationships required to properly administer the various financial functions of CalOptima.
- Maintains adequate insurance and reinsurance coverage.
- Oversees health plan and provider financial audit and compliance activities as they relate to financial reporting, payment of provider capitation, and payment of provider medical claims.
- Ensures the development, implementation and adherence to financial procurement policies that meet CalOptima’s performance needs and appropriate commitment of funds.
- Other projects and duties as assigned.
- Lead investment management activities.
- Understand proposed rate structures.
- Integrate financial, operational and medical management activities to achieve performance improvements.
- Provide sound fiscal leadership while supporting organizational growth and improvement.
- Develop traditional business banking functions and investment policies.
- Develop necessary financial strategies, budgets and fiscal monitoring to ensure the overall fiscal integrity of a publicly financed agency.
- Analyze the need for and develop supporting proposals for any necessary federal waiver or changes in State policies or legislation.
- Establish a sound program of insurance and reinsurance to protect the fiscal integrity of the program.
- Oversee all applicable tax and regulatory compliance activities.
- Communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
- Encourage the professional performance and development of subordinate staff.
- Interpret financial analysis and performance; ability to prepare reports using compiled financial data; skill in using electronic spreadsheets and databases.
Experience & Education:
- Bachelor’s degree in Accounting, Finance, Business, or closely related field with 8+ years relevant experience is required. Master’s degree with 6 years experience strongly desired.
- Active CPA certification highly preferred.
- Progressively responsible experience within health care service delivery and/or managed care required.
- Experience with capitation, pay for performance, risk sharing, and provider contracts required.
- Experience with actuarial-based rate setting methodologies, state and federal contracts, and regulatory audits required.
- Financial management experience with functions such as IBNR, annual budget, reinsurance, and payroll required.
- Public agency experience preferred.
- Health plan financial management including rate development, provider payments, incentive alignment, utilization management and CMS bid preparation/ contracting.
- Generally accepted accounting principles ("GAAP"), Medicare and Medicaid regulations.
- Federal and state Medicaid fiscal policies.
- Analyses to ensure the State of California fully funds its obligations to Medi-Cal beneficiaries in the CalOptima program.
- Generally accepted auditing standards ("GAAS").
- Functional requirements for the appropriate and timely payment of medical claims.
- Principles and techniques of effective supervision include training and evaluation.
- Principles and practices of procurement by a public agency.
Master Of Business Administration (Mba)