Health Actuary Director|
This position is responsible for managing all activities related to managed care and other risk based capitation rate setting, risk adjustment, and actuarial work for the Minnesota Health Care Programs for contracts serving the Medical Assistance program (families and children, seniors and disabled special needs purchasing) and the Minnesota Care program. The incumbent provides expert actuarial work to ensure innovative and effective development, analysis, review and implementation of capitation rates and risk adjustment to ensure compliance with federal and state regulations governing Medicaid programs, Basic Health Plan programs, and local and national insurance regulations.
This position provides leadership and direction to various outside consultants who support managed care or other risk-based purchasing rate setting including contracted health actuaries, as well as internal staff involved in capitation rate setting and payments and risk adjustment. This position also manages DHS’ processes and policy development around health plan financial data collection, analyses, auditing, and risk adjustment. The position collaborates with and advises DHS senior management, and other agency and cross-agency efforts involving and/or impacting health care purchasing and rates, such as demonstrations, delivery and payment reform efforts, managed care procurement and contracting, and legislation.
The position will also need to oversee the development and maintenance of modeling tools to evaluate impacts of potential changes, as well as the processes and system capabilities for making capitation claims payments.
• Manage the development and evaluation of managed care and other risk-based rates, risk adjustment activities, and capitation payments for the Minnesota Health Care Programs
• Manage the submission, review, analysis and reporting of health plan and participating entity financial filings
• Perform or coordinate actuarial research, studies, or other special projects requested by the legislature or department leadership. Provide supervision and input into the analysis and development of policies to regulate managed care organizations, particularly with respect to department and state budget impacts, health plan financial impacts, and health care industry economic impacts
• Manage and direct the work of the managed care capitation rates and payment team
Qualifications & Requirements
• Fellow in the Society of Actuaries and a Member of the American Academy of Actuaries
• Five (5) years of experience in pricing of health insurance including;
o Minnesota’s health care industry;
o Deep knowledge of actuarial science, insurance finance and insurance operations in the health lines of business;
o Procurement and payment methods.
• Knowledge and expertise in capitation rates, risk adjustment methodologies, statistical theory and analysis, and health plan financial data and payment systems.
• Understands the context, application, and impact of his/her statistical data, projections, and recommendations and recognizes the policy, contractual, and legal implications of his/her end products