Chief Financial Officer - Prominence Health Plan

UHS•Spring Valley, NV

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. The Chief Financial Officer (CFO) is an executive level management position of Prominence Health Plan responsible for the financial activities of the Prominence Health Plan companies. Responsibilities include Health Plans accounting and financial reporting, regulatory and statutory accounting, planning and analysis, budgeting, oversight of actuarial services, underwriting and financial pricing decisions, IBNR reserve preparation, premium billing and collection, and oversight and coordination with the centralized accounting, reporting, and accounts payable functions provided by corporate accounting. Additionally, this executive is responsible for the coordination of the annual reinsurance program. This executive also actively participates with the CEO and other key executives in the development and implementation of key strategic initiatives. The CFO reports directly to the CEO.

Requirements

Master’s degree required, a minimum of 8-10 years of experience.
Travel: Ability and flexibility to travel to current and future markets – 10%+ travel.
Health Plan Financial reporting, accounting, and analytics.
GAAP, Statutory, and Management reporting.
AP/AR oversight.
IBNR.
Actuarial services.
Cash flow management.
Annual budgeting and strategic financial planning.
M&A Activity, Investor Relations, Joint Venture Investments.
Lines of Business.
Medicare Advantage, Commercial, Self-Funded/ASO.
Extensive understanding of Medicare Advantage and Federal program financials.
Significant experience with Bid Submission.
Medicare Advantage Risk Adjustment & STARS.
Commercial business underwriting.
RBC – Risk Based Capital.
Traditional payer contracting, value-based contracting including risk and capitation.
Reinsurance/Stop loss strategies.
Experience with other Federal Medicare programs – ACO models, MSSP programs, Direct contracting, PBCI, Etc.
Team leader and individual contributor.
Start up culture managed by a Fortune 300 entity.
Strategic perspective on the industry with ability to be hands on and comfortable with the details.
Passion for execution.
Nimble organization with decision making power and limited politics.
Passion for being part of driving healthcare initiatives and change under a broader population health, value-based strategy.
Significant experience traversing deep financial details and activities and summarizing to more strategic and directional conclusions for corporate oversight and organizational execution.
Ability to effectively communicate in English, both verbally and in writing.
Microsoft Office experience.
Strategic but practical thinker that can take concepts from its initial stage through implementation to administration.
Excellent communicator who is equally comfortable with external stakeholders as well as internal stakeholders.
Demonstrated ability to build a highly functioning team and to mentor direct reports.
Experience with Commercial, self-funded, and Medicare Advantage products.
Proven ability to foster collaboration between divergent stakeholders.
High degree of credibility with key stakeholders based on past accomplishments.
Experience in negotiating complex provider reimbursement arrangement and complex third-party contracts.
Adept in managing outsourced vendor relationships in compliance with NCQA and CMS delegated entity rules.
Comfortable in managing interfaces with Prominence functional areas and third-party partners.
Proven ability to drive organization through cultural change, focused on individual accountability and performance.
Solid understanding of health plan key financial drivers.
Service excellence orientation toward external and internal stakeholders

Responsibilities

Leads and manage respective functional areas: accounting, financial reporting, regulatory reporting and statutory accounting, actuarial services, premium billing, and accounts payable.
Supervises the Health Plan financial reporting process.
Supervises the preparation of reports outlining the Health Plan’s financial position and operating profit and loss statement.
Supervises the preparation and timely filing of federal and state financial reports as required.
Works cooperatively with UHS’s corporate financial services on all Health Plan Financial matter.
Ensures connectivity of Prominence Health Plan infrastructure development to broader UHS corporate value-based care strategy.
Manages relationships with respective outsourced vendors, partners, and key provider groups.
Initiates and drives activities to advance quality, improve member, provider, and employee satisfaction, optimize revenue, reduce expenses, and increase productivity.
Oversees the budgets for each of the functional areas, review monthly, and ensure performance is achieved.
Ensures data-driven decision making across the organization through robust and proactive analytics strategy.
Represents Prominence Health Plan and UHS strategic initiatives in all its respective and future markets to external partner, prospective employees, etc. Serve as back up to CEO when needed.
Executes and implements the organization’s strategic goals by interfacing and ensuring connectivity across the organization’s leadership.
Develops and implements initiatives to contribute to strategic and profitable growth of organization.
Performs other duties as necessary and assigneds