BACKGROUND - CANOPY HEALTH
- Canopy Health, formed in 2015 with leadership from UCSF and John Muir Health (JMH) and with participation from additional, leading Bay Area providers, is creating an integrated healthcare experience where quality care and coverage are provided by an alliance of the top caregivers across the Bay area, allowing people to access the best options for their personal needs. Owned by physicians and hospitals, Canopy Health is a community of caregivers championing health. Our focus is on improving health, advocating for the entire Bay Area, and supporting individuals in a way that is empathetic and respectful. Our large network of physicians and other providers will offer consistently high-quality care with clear, foreseeable costs.
- Founded in 2015, BayHealth Development is a University of California San Francisco Health (UCSF) and John Muir Health (JMH) joint venture company focused on infrastructure development supporting the needs of the Canopy Health accountable care network, and serving as a joint strategic investment vehicle in support of the UCSF/JMH affiliation. BayHealth Development is deeply committed to value creation in the Canopy Health network and our shared vision with UCSF/JMH for innovation in patient experience, access, affordability and quality of care.
- This position reports to the CFO of Canopy Health and BayHealth Development. This position will work with senior business leaders in both organizations and will interact with the health plan, provider and vendor partners.
- The Actuarial Consultant will be a strategic partner of Canopy Health and BayHealth finance leadership team. The Actuarial Consultant will work with finance leadership to develop leading practice finance and actuarial capabilities to support the achievement of the strategic goals of Canopy Health and Bayhealth.
- Build strong relationships and coordinate effectively with Canopy Health and Bayhealth leadership, vendors, investors, partner provider systems, and health plans and other stakeholders
- Develop and maintain leading practice finance and actuarial processes, models and capabilities to support business leadership
- Create and maintain annual, multi-year financial plans, 12-month rolling forecasts and performance dashboards
- Ensure timely and accurate month-end close, quarterly and year-end processes related to the reserves, contract modeling, pricing, planning and forecasting
- Compare actual results to budget and forecast; prepare and report insightful variance analyses to identify risks or opportunities and use data to influence leadership decisions
- Partner with finance and business leadership team to prepare insightful and compelling board and subcommittee presentations
- Streamline the consolidation, analysis and flow of actuarial and financial information from/to health plans, providers, vendors, facilities, and project owners to ensure accurate, transparent and timely reporting
- Pricing analysis, risk management, reserving, forecasting, trend setting and actuarial administration including conducting analysis, monitoring, evaluating, and reporting of the effectiveness of Health Plans rating formula and participating in the development of new products
- Provides actuarial support for data reporting, financial forecasting/projections, creating filings and/or performing financial and risk analysis in changes to provider contracts to help meet company goals of providing low-cost healthcare and meeting earnings objectives
- Conduct and develops analysis, assess risk and population risk scores and assignment, develop trends, assess changes in benefit designs, and/or evaluates actuarial risk related analysis
- Coordinates, prepares, perform and audits actuarial and financial analyses to assist in the development of complex actuarial formulations leading to the recommendation of pricing, trending, reserving, provider reimbursement and/or risk assessment strategies
- Maintains documentation or actuarial analysis and models as well as provides consultation and clarification on actuarial models and other actuarial work products.
- Requires college degree with at least a minor in mathematics, statistics, computer science or equivalent business experience
- ASA designation and has completed 1 to 2 courses toward their FSA designation
- Requires deep knowledge of healthcare economics obtained through professional experience and advanced education
- Typically viewed as a specialist within the Actuarial role and has expert knowledge in the following areas:
- Pricing for credible and non-credible populations
- Medicare Advantage pricing and bid process
- Small and Individual rate development
- Large group pricing and underwriting
- Trend development
- Provider contract modeling and forecasting
Requires a minimum of 6 to 7 years of professional
actuarial experience for one or more healthcare
organizations (health plan, integrated health system / complex hospital, large
IPA, ACO, healthcare company).
- Successful leadership experience within California or in a similarly mature managed care market characterized by a delegated model and capitated or other risk sharing contracts
- Established track record of delivering accurate, compliant, timely and insightful financial and actuarial analysis
- Ability to forecast, anticipate, and respond to trends and challenges, working collaboratively with leadership, providers and health plan partners
- Understands the core principles and functionality of decision, descriptive, predictive and prescriptive analytic methods including forecasting, statistical and machine learning techniques. Has knowledge of the requisite analytic tools and techniques and can manage and own an advance analytic based project from end to end
- An adaptable and innovative leader with a tolerance for ambiguity; possesses the ability to lead and thrive in a dynamic environment marked by rapid change
- Delegates appropriately and effectively; can lead through influence to obtain necessary resources
- Can effectively build, lead, and scale a high-performing financial planning and actuarial analysis operation
- Ability to determine key business issues and independently develop action plans
- Can explain advance analytic projects to audiences outside of their job function. Acts as the subject matter expert in the data areas of claim, premium, membership, and/or risk score assignment
- Significant experience managing people, with strong, professional communication and writing skills
- Strong knowledge of finance and actuarial practices and principles
- Experience with general ledgers, planning databases and report writing