Lead Decision Support Analyst (principal Financial Analyst)

Lead Decision Support Analyst (Principal Financial Analyst)

CalOptima Health is seeking a highly motivated Lead Decision Support Analyst (Principal Financial Analyst) to join our team. The Principal Financial Analyst (Decision Support) will be responsible for providing highly complex analysis, guidance and expert knowledge on health care finance for various departments within CalOptima Health. The incumbent is a sought-out expert and company-wide resource on matters of health care finance. Working independently, the incumbent will lead complex large-scale analytical initiatives, develop report suites and financial models used to forecast medical cost trends. The incumbent will provide expertise for provider contract negotiations, assess actuarial rate development studies, participate in annual budgeting functions, lead ad-hoc teams and serve as a subject matter expert to staff and other consultants within the department. The incumbent will evaluate high visibility complex issues, perform detailed analysis and communicate well reasoned, thorough solutions to all levels of management within CalOptima Health. The incumbent will work with large amounts of claims, enrollment and provider data.

Position Information:

• Department: Financial Analysis

• Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322)

• Work Arrangement: Partial Telework

This position is eligible for telework in California.

Duties & Responsibilities:

• 95% - Financial Support

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.

• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.

• Shares expert knowledge, mentors, trains and serves as a lead for analytical staff.

• Serves as a subject matter expert in the following areas: Medi-Cal provider rate methodology, Medicare provider rate methodology, Department of Health Care Services (DHCS) revenue, Centers for Medicare & Medicaid Services-Medicare Advantage (CMS-MA) revenue, population health member cohort identification, industry standard approaches to health care cost service categorization and metrics.

• Forms and leads ad-hoc teams on key initiatives.

• Provides expertise and analyses around risk adjustment.

• Leads in the design, development, implementation and maintenance of report suites and dashboards for all levels of CalOptima Health management.

• Researches, assesses and develops advanced tools, models, reports and approaches to increase accuracy and timeliness of data-driven work projects.

• Develops medical expense, revenue and enrollment projections to support the budget process.

• Develops financial models and reports to support provider contract negotiations.

• Develops return on investment and business case analyses for program initiatives under consideration by management.

• Provides clinical and utilization analysis to assist Medical Management with improving outcomes and quality of care for CalOptima Health members.

• Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse.

• 5% - Other

• Completes other projects and duties as assigned.

Minimum Qualifications:

• Bachelor's degree in business administration, finance, economics, actuarial sciences or related field PLUS 8 years of financial analysis experience in managed care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

• 5 years of experience in Provider Contract Modeling, Provider Rate Analysis and/or Managed Care Contracting in a health care setting required.

• 1 year of experience writing SQL required.

Preferred Qualifications:

• 5 years of analytical experience working with Medi-Cal and/or Medicare payer information.

• Experience in an Independent Physician Association (IPA), hospital or health plan setting.

• Intermediate to Advanced proficiency in Excel.

• Experience with DHCS rate development and/or Medicare Advantage bid process.

Required Licensure / Certifications:

• N/A

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.

• Work independently and exercise sound judgment.

• Communicate clearly and concisely, both orally and in writing.

• Work a flexible schedule; available to participate in evening and weekend events.

• Organize, be analytical, problem-solve and possess project management skills.

• Work in a fast-paced environment and in an efficient manner.

• Manage multiple projects and identify opportunities for internal and external collaboration.

• Motivate and lead multi-program teams and external committees/coalitions.

• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.

• Ability to speak (enunciate) clearly in conversation and general communication.

• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.

• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.

• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.

• There are no harmful environmental conditions present for this job.

• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.

• There may be harmful or hazardous environmental conditions present for this job.

• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.

• Employee will occasionally work outdoors in varied temperatures.

• There may be harmful or hazardous environmental conditions present for this job.

• The noise level in this work environment is usually moderate to loud.

About CalOptima Health:

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About our Benefits & Wellness Options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options.

Important Application Information and Instructions:

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 2, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early