HSCSN Fin Program Director

HSCSN Fin Program Director (260001FZ) Job Summary: The Director of Finance, Managed Care will act as the primary backup to the VP of Finance, overseeing all financial operations related to the managed care services budget, budgeting, provider contracting, business analytics, and planning functions for the $190 million managed care services budget. Responsibilities Oversee all finance-related activities for the managed care entity, including developing and monitoring progress against the annual budget, identifying medical cost trends, and participating in medical cost improvement initiatives. Implement CMS, DHCF, and DISB requirements related to medical loss ratio reporting, fiscal soundness reporting, audit assistance, analysis of service utilization, drug utilization, and other cost trends; lead all internal and external reporting activities. Manage and monitor finance activities related to the Master Services Agreement (MSA) with Children’s and the related division of responsibilities. Lead rate‑setting activities by coordinating with DHCF and consulting actuaries. Provide insight and analysis on provider contracting and data analytics, particularly regarding Value Based Purchasing (VBP). Support Provider Relations with development of financial payor models and benchmark comparisons. Plan, develop, and prepare complex reimbursement models, including but not limited to value‑based payment, population health management, risk and capitation to determine payor contract terms. Review and analyze statistical, cost, and financial reports for complex payor contracts. Conduct retrospective review of claims payment history. Monitor the volume of monthly authorizations and provide projections on potential financial impact. Validate capitation revenue payments and reconcile with sources such as QNXT, 820, and 834 files. Stay abreast of financial and regulatory matters affecting managed care services and ensure compliance with all federal and local laws. Lead establishment of organizational and departmental performance metrics, review performance, and implement corrective action plans. Review monthly performance and financial results, provide recommendations to senior management, and design analytical financial dashboards. Serve on various managed‑care services committees (Vendor Relations, BUMC, IS User Group, etc.). Review historical operating results to identify revenue enhancement and cost‑saving opportunities. Plan, review, and execute annual year‑end audits. Handle special projects assigned by the VP of Finance. Qualifications Minimum Education : Bachelor's degree in Finance, Business, or Accounting (required). Master's degree preferred. Minimum Work Experience : 10 years of health care financial management experience with managed care (preferred); 5 years of finance leadership roles (required). Required Skills and Knowledge : Proficient in Microsoft Word, Excel, and Outlook. Advanced data analysis using PivotTables, Excel spreadsheets, and additional analytics tools such as Tableau and Power BI. Knowledge of Medicaid Managed Care operations. Ability to monitor and report financial performance of provider and vendor contracts and ensure compliance with contracting guidelines. Experience in department budgeting, financial reporting, and budget review. Capability to develop and administer budgets, including capital budgets, to achieve strategic objectives. Project management skills to ensure adherence to budget, schedule, and scope. Analytical skills to forecast population health trends and evaluate medical claims, membership, care management, and utilization management data. Experience with large‑scale customer contracting and integrated commercial organizations. Excellent interpersonal, relationship management, oral, written, and presentation skills. Ability to foster collaboration, engage others, and secure support for proposals. Proven ability to lead through change and manage business growth. Strong knowledge of strategic planning, data analytics, and dashboard development. Experience with business intelligence software and enterprise systems. Required Licenses and Certifications : CPA license upon hire (preferred). Additional Information Primary Location: District of Columbia–Washington Work Locations: Remote Work Location 111 Michigan Avenue NW, Washington, 20010 Job Type: Non‑Clinical Professional Organization: HSC W/Special Needs Position Status: R (Regular) – Full Time – Day shift (M–F) Full‑Time Salary Range: $101,275.20 – $168,792.00 Equal Opportunity Employer Health Services for Children with Special Needs (HSCSN) is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “Know Your Rights” poster is available here and the pay transparency policy is available here: Know Your Rights Pay Transparency Nondiscrimination Poster. HSCSN maintains a drug‑free workplace in accordance with the Controlled Substances Act. The policy applies to all staff, including management, employees, and contractors; recreational and medical marijuana are prohibited. #J-18808-Ljbffr Children's National Medical Center