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Manager, Financial Analysis

CalOptima Orange Full-Time
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This position facilitates decision making by providing actionable financial analysis. The position is responsible for the development of complex analyses and models to support program, policy, and strategic initiatives.  The incumbent will have direct involvement in the development of new analytics and data reporting projects that will help drive more efficient business decisions.  This also includes but not limited to the development of models to evaluate and analyze the financial implications of programmatic and policy changes under consideration throughout the organization.

Position Responsibilities:

  • Manages, hires, trains, develops staff within area of responsibility.
  • Provides direction and guidance for financial analysis staff in performing their duties in accordance with established departmental and organizational policies.
  • Develops clinical utilization, cost profile, and other indicators for all areas of medical costs.
  • Provides statistical modeling to accurately forecast expense, revenue and enrollment trends.
  • Creates financial models and reports to support provider contract negotiations.
  • Research, assess, and develop advanced tools (Business Intelligence reports, dashboards, and databases) models, and approaches to increase accuracy and timeliness of data-driven analytic projects.
  • Analyzes state capitation rates and evaluate the accuracy and appropriateness of applicable reimbursement policy and adjustments.
  • Establishes annual medical expense budgets for all lines of business.
  • Develops return on investment and business case analyses for program initiatives under consideration by senior management.
  • Builds Medicare revenue models to accurately forecast financial impact of clinical and demographic changes.
  • Contributes to the evaluation of decision support and analysis tools, as well as collaborate with the Data Warehouse Team.
  • Presents, and communicates methodologies, concepts, and results to all levels of management.
  • Other projects and duties as assigned.

  • Assess and analyze complex financial and health care data.
  • Prepare and present complex financial reports in concise and understandable formats.
  • Work with tight deadlines and multiple internal customers with competing priorities.
  • Communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
  • Develop the engagement of subordinate staff.
  • Assist in the formulation of policies and procedures; understand and interpret policies, procedures and regulations.
  • Effectively utilize computer and appropriate software (e.g. Microsoft SQL Server, Access, Excel, and Word).

Experience & Education:

  • Bachelor’s degree in Health Care Administration, Economics, Accounting, Finance or other related field; 3 years supervisory experience, preferably in a health care environment or equivalent combination of education and experience sufficient to successfully perform the essential duties of the job, such as those listed.
  • 5+ years of health care informatics required.
  • Experience in report/analytics development preferred.

Knowledge of:

  • Principles and practices of managed health care industry and strategies, provider contracting, IBNR, pricing and rate setting, claims, provider network structures and risk sharing arrangements.
  • Familiarity with standard financial reporting structures and experience in the development of health systems reporting tools, including business intelligence best practices, outcomes and performance measures.
  • Principles and techniques of effective supervision, including training and evaluation.

Grade:  O


Recommended skills

Reporting Tools
Financial Statements
Financial Analysis
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Job ID: 98460-072319


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Better. Together.

Our mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner.

CalOptima is a county organized health system that administers health insurance programs for low-income families, children, seniors and persons with disabilities in Orange County.

As Orange County’s largest health insurer, we provide coverage through four major programs.

Medi-Cal (California's Medicaid Program) for low-income children, adults, seniors and people with disabilities 

OneCare (HMO SNP) (a Medicare Advantage Special Needs Plan) for low-income seniors and people with disabilities who qualify for both Medicare and Medi-Cal

PACE (Program of All-Inclusive Care for the Elderly) for older adults, providing comprehensive health services through the CalOptima PACE center

OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) for people who qualify for both Medicare and Medi-Cal, combining Medicare and Medi-Cal benefits, adding supplemental benefits for vision, transportation and dental services, and providing comprehensive care coordination

“Better. Together.” is our motto, but it’s also our philosophy. We believe that by working together, we can make things better – for our members and community.

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