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   Current UPMC employees must apply in HR Direct

Value Based Contracting Manager, Actuarial Services (REMOTE, US)

Description

UPMC Health Plan's Actuary department is seeking a Value-Based Contracting Manager, Actuarial Services!

Ensures that the Actuarial Department provides excellent services to various internal and external clients in the areas of provider relations, contracting and forecasting.  Responsible for supervising actuarial analysts.  Presents to senior financial leadership.  Participates in the design and negotiation of new value-based contracts.

This position can be remote; based anywhere in the continental US. Apply today!

Responsibilities

  • Determine the performance measures, associated benchmarks, and other contractual components to include in new formed value based contracts. Assures reliability of measures and statistical methodologies in tracking performance.
  • Provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
  • Analyze Fee For Service arrangements, contract changes, and project future unit cost trends. Calculate values of network relativity factors used in rating and underwriting. Evaluate and model alternative payment models (e.g. per diem vs DRG, bundled payments, case rates).
  • Provide expertise to Contracting and Network services areas in rate modeling and fee schedule preparation, training, process development, etc.
  • Create and analyze ACO contracts, PCMH arrangements, Global Capitation, Bundled Rates, Episodic Payments, Capitation, Risk Adjusted Total Cost of Care, and Value Based Payments.  Review risk/shared savings payouts and accruals.
  • Ability to learn new lines of business to help UPMC Health Systems to expand into different arenas such as Stop Loss Insurance or Workers Compensation.
  • Work closely with Enterprise Risk Management and key internal stakeholders to build and enhance insurance (underwriting and reserving) risk assessment, monitor changes to the risk profile, risk analytics, and understand key drivers.
  • Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, including IBNR calculations and Data Analysis.
  • Ability to solve issues with a sense of urgency.
  • Performs in accordance with system-wide competencies/behaviors.
  • Performs other duties as assigned.

 

Qualifications

  • Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required.
  • Advanced degree preferred.
  • Six and a half (6.5) years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
  • Experience with commercial and government health programs is preferred.
  • In-depth understanding of health insurance market dynamics.
  • Management experience preferred.


Licensure, Certifications, and Clearances:
Licensure/Certification: ASA or FSA certification by Society of Actuaries required.Membership in the American Academy of Actuaries required.
 

  • Associate of the Society of the Actuaries Certificate OR Fellow of the Society of Actuaries Certificate
  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct