Manager-Actuarial Services

The Manager, Actuarial Services will lead a team of financial analyst and actuaries to perform managed care analytics and complex data modeling, using cost and reimbursement databases such as Strata, EPIC, Click, etc. The Manager, Actuarial Services will take the leading role in rate setting for the entire OSUWMC enterprise including, but not limited to, The Ohio State University Wexner Medical Center on behalf of its University Hospitals, its Arthur

G. James Cancer Hospital and Richard J Solove Research Institute and its University Reference Laboratories, The Ohio State University Physicians, Inc., Community Outreach, Mount Carmel Alliance, Student Health Plan and College of Dentistry. The Manager, Actuarial Services will have additional matrixed management and leadership responsibilities for a shared resource with the Pharmacy Department. The Manager will be highly involved in innovative product and program development tied to the departmental and organizational strategic plan.

Job Responsibilities:

• Produce monthly/quarterly physician and hospital utilization and reimbursement reporting to support managed care functions.

• Produce cost/utilization reporting for employer groups including the Ohio Department of Rehabilitation and Corrections (ODRC) to assist in managing the total cost of care.

• Load and maintain managed care contract rate tables within decision support system (aka, Strata).

• Support analytics and reporting for value based reimbursement and value based discount arrangements.

• Maximize managed care reimbursement by targeting rate increases that align with strategic growth areas and high volume procedures.

• Validate impacts of charge master changes and make recommendations to Sr. Leadership as needed.

• Support Direct-to-Employer (D2E) initiatives through advanced analytics and reporting.

• Produce and maintain funds flow models.

• Produce and maintain bundle payment models.

• Rebase physician reimbursement tables that are tied to a specific year of Medicare as needed.

• Produce and maintain pharmacy utilization and reimbursement reports.

• Manage direct reports and matrixed staff with assigned projects and daily assignments.

• Act as managed care revenue subject matter expert with frequent interactions with Sr. Leadership.

• Develop the organizations premium rate structure through forecasting of financial and statistical data in a manner which is actuarially sound and competitive within the market.

• Incorporate organizational expectations for the financial impacts of clinical integration, population management processes, managed care contracts and benefit structures into rates and financial projections.

• Support development of provider fee schedules, capitation rates, gain sharing programs and other contractual arrangements.

• Develop pricing models using mathematical modeling techniques and statistical concepts to determine probability and assess risks.

Minimum Requirements:

• Bachelor's Degree in Actuarial Science or an equivalent combination of education and experience.

• Associate of the Society of Actuaries.

• 7 years of relevant experience required. 12 or more years of relevant experience preferred.

• Experience with EPIC and Strata systems preferred

Our Comprehensive Employee Benefits Include:

• An array of retirement plan options, each with a generous employer contribution.

• Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.

• Paid vacation and sick leave, including short and long-term disability and paid parental leave.

• Get the most out of the Public Service Loan Forgiveness program.

• And much more!