Created in 1998, VNSNY CHOICE is the managed care affiliate of the Visiting Nurse Service of New York and shares its mission of compassion and care for the poor, the chronically ill and elderly. Our guiding principle is to help the most vulnerable among us live safely and independently for as long as possible in their own homes and communities. VNSNY CHOICE has 700 employees, including 227 care management staff. On any given day, VNSNY CHOICE coordinates care for more than 40,000 members through its array of Medicare and Medicaid health plans, including Medicaid Long Term Care, Medicare Advantage, and a HIV/Special Needs Plan. With offices in Manhattan, Brooklyn and upstate New York, VNSNY CHOICE health plans are available in the New York City metropolitan area as well as on a plan basis in selected counties throughout New York State.
Responsibilities and Qualifications:
Responsible for providing strategic leadership to the management of financial exposure associated with health care benefits not typically offered in a home care environment, which includes coverage risk for inpatient and sub-acute facility costs, outpatient procedures, primary and specialist physician care, diagnostic procedures, and pharmacy expenses. Responsible for the soundness of reported medical claims reserves. Evaluates the viability of potential new risk-based initiatives. Monitors the soundness of financial process controls. Provides input on benefit design issues. Oversees and/or contributes on regulatory reporting and rate filing issues. Works with the Director of Finance to ensure optimum utilization of financial resources and alignment of strategic short and long-term goals according to the Agencys business plan. Works under general direction.
Licensure: Associate Status in the Society of Actuaries (ASA) required. Progress towards FSA status, with an emphasis on health care preferred.
Education: Bachelors Degree in Mathematics, Actuarial Science, Statistics, or related discipline, required. MBA, MPH, or MPA preferred.
Experience: Minimum five years of progressively responsible actuarial/finance experience in a Managed Care or related organization (three years for Masters qualified) required. Understanding of community rated and individually risk-adjusted funding mechanisms, provider reimbursement arrangements, and member risk classifications required. Two years supervisory experience required. Outstanding PC skills, including Excel, Access and VBA required. Excellent analytical and presentation skills, required. Experience with SAS, Oracle Discoverer or equivalent software preferred. Knowledge of PeopleSoft or Oracle accounting software preferred.