Director Medical Economics Forecasting-SWHR (Finance)
Director Medical Economics Forecasting-Southwestern Health Resources-Clinically Integrated Network (SWHR-CIN) Leading the Medical Economics department for Southwestern Health Resources by designing and overseeing integration of data analytics and modelling necessary for supporting the overall executive objectives and strategies. Responsible for all financial modeling and forecasting of all value-based care contracts.
• Work location: Southwestern Health Resources Headquarters, Farmers Branch, TX .
Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region's leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N' Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region.
The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
Position Duties Responsible for the strategic design and development of tools to measure the leading cost drivers to support the integrated decisions needed for operations, clinical, and financial executive leadership teams
Oversees advanced analytics to enable rich insight from multiple external data sets, scenario modelling and simulations to drive the strategic vision to improve financial performance tied to medical and pharmacy cost trends.
Monitors SWHR and market cost data and trends to determine potential external impacts or opportunities for SWHR in its full risk arrangements and other gainshare arrangements. Supporting the continuum of analytics needed for senior leadership from financial, operations and clinical areas.
Oversight and monitoring the key contractual payor levers by the continual monitoring of SWHR subset of key leading cost drivers continues to support the most optimal contractual performance given various contractual levers, stop loss threshold, DOFR exclusions, and shared savings/loss thresholds.
Develop outcome-based metrics to monitor and identify program effectiveness encompassing the financial expenses, quality outcomes, patient and provider satisfaction results, operational performance, and contractual performance needed to inform senior leadership on evaluation of program.
Supporting financial return calculations for proposed quality and risk initiates, post-acute models, other network operation opportunities. Strong attention to detail and be able to apply sound mathematical skills to reporting and validation processes.
Provide strategic and financial advice when working with consulting actuaries to develop and utilize actuarial models, analyze healthcare cost and utilization data, complete actuarial calculations, and implement software solutions. Communicate regularly with financial directors and internal/external stakeholders at all levels (including executive heads).
Strong partnership with Data Analytics and Finance teams to ensure accuracy in reporting and validation across payor reported files. Also, responsible for the forecasting and financial reporting of all value-based care contracts. Including but not limited to quality/RAF performance, shared savings(loss), and validation of all dollars shared between the various external parties.
Responsible for the strategic design and administration of the physician compensation programs at Southwestern Health Resources. Develops, implements, and administers physician compensation strategies, models, and programs. Oversees and implements controls and procedures across multiple departments to ensure timely reporting, accurate and compliant reporting and payouts. Establish compensation plans and incentives, direct the preparation of compensation models, determine fair market value and commercial reasonableness. Support associated reporting, create and maintain policies and best practices, monitor industry trends involving physician compensation such as virtual bundles for specialists, and ancillary gain share arrangements etc. Ensuring compensation models and practices are effective, timely enforced, and compliant and aligned with strategic objectives.
Education Bachelor's Degree in Business or Finance required. Or, Master's Degree Business or Finance preferred
Experience8 years progressively responsible, related experience to include at least three (3) years in supervisory capacity required
SkillsWorks requires expert knowledge of advanced data science and complex analytical skills
Work requires understanding of Accountable Care Organizations, models, and contracts.
Work requires demonstrated database, analytical, and presentation skills.
Work requires independent, prudent problem solving.
Work requires good interpersonal, customer service, supervisory, organizational, and leadership skills.
Work requires ability to review, develop, recommend, and implement policies.
Work requires exercise of considerable judgment and great attention to detail.
Must be able to communicate frequently and openly with leadership team to produce environment that is collaborative and high-performing
Why Southwestern Health ResourcesAs a Southwestern Health Resources you'll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
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