You Make Us Grow. You Make Us Sharp.

Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$79.420 - $102.480 - $125.540

The 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 - PREFERRED

Essential 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 in higher standard.
  Financial Reporting - Develops and oversees 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. Oversees the preparation of financial analyses of health plan and provider contract activity, including the financial viability of contract provisions based on current experience, sub-capitation arrangements, etc. Oversees the preparation of HMO Medical Fees standard and ad hoc reports for affiliated medical groups. Oversees point system or other utilization reports on a quarterly basis.
  Measure - Standard represents Meets/Meets and Exceeds. Quality of financial reporting determined by the Vice President, Managed Care through review of reports and customer feedback results in higher standard.
• EMPLOYEE MANAGEMENT
  Employee Management - Demonstrates effective employee management by:
  Ensuring that 100% of employee performance appraisals are accurately completed within 30 days of employees' anniversary dates in order to achieve Meets/Meets and Exceeds Standard.
  Effectively manages and ensures effective management of performance issues relative to employees under direct and indirect supervision, respectively. Proactive identification and problem solving relative to performance issues; assuring consistent application of Human Resource Policies and department protocol, appropriate follow-up with employees and feedback to the Vice President, Managed Care as to ongoing results. No significant exceptions as observed by the Vice President, Managed Care is expected to receive Meets/Meets and Exceeds Standard. Lack of minor exceptions will result in a higher standard.
• LEADERSHIP
  Documented effective participation on the Sharp Rees-Stealy and Sharp Mission Park committees, hospital finance preparation committees and task forces as requested.
  Measure - Effectively participates on the Sharp Rees-Stealy and Sharp Mission Park committees and in three to four committees peer year without the occurrence of negative legitimate feedback from committee members. Standard represents Meets/Meets and Exceeds. Quality of participation and lack of negative feedback results in higher standard.
  Provides effective leadership of the Managed Care Finance department, including properly motivating staff, ensuring optimum levels of productivity and reporting, developing responsibilities, re-engineering work load, etc.
  Measure - Standard represents Meets/Meets and Exceeds. Effectiveness of leadership as determined by the Vice President, Managed Care through dealings with the Manager and through customer feedback results in higher standard
• SYSTEM INTEGRATION
  Oversees the successful and timely incorporation of additional managed care contracts, operating units or medical groups into the responsibilities of the Managed Care Finance department. Oversees the timely incorporation of revisions in managed care contracts into financial analyses. Oversees that reporting and service levels are comparable across the System and across affiliated medical groups.
  Measure - Standard represents Meets/Meets and Exceeds. Quality of feedback from customers obtained by the Vice President, Managed Care results in higher standard.
  Innovation: Recommends, develops and implements managed care financial policies and procedures to improve quality and timeliness of reporting and efficiency of Managed Care Finance operations, to ensure that service levels are consistent among operating units, hospitals and affiliated medical groups, to capture previously-lost funds (i.e., capitation sub-capitation, insured services, stop-loss), to reduce operating costs, to more effectively negotiate health plan contracts, to ensure effective communication between Senior Management, Contracts, Claims Administration, Financial Services, CFO's, Patient Financial Services, Utilization Review, Medical Groups and Hospitals, etc.

Knowledge, Skills, and Abilities

• Familiarity with automated financial systems and microcomputers required.
• Effective communication and interpersonal skills; oral and written.
• Ability to develop new products and services relative to Managed Care.
• Oversee the analysis and interpretation of data, we well as prepare or direct the preparation of concise, accurate and meaningful reports and financial analyses. Knowledge of Generally Accepted Accounting Principles.
• Knowledge of managed care financial practices including the accounting and financial analysis of capitated contract risk pools (calculation of incurred but not reported [IBNR] claims), methods of calculating hospital and physician utilization (e.g., bed days or encounters per thousand), etc.
• Ability to effectively administer and manage multiple departments, people and priorities.
• Ability to work effectively with physicians, physician committees, employees, management and peers. Ability to achieve results for the organization with and through other people.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Bachelor's Degree; Certified Public Accountant (CPA) - CA Board of Accountancy