Job Number: 20013049

Location: Brentwood, TN

Date Posted: 7-15-2017

Job Title: Director, Actuarial Services

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Why naviHealth?

naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, developers, and healthcare leaders to create and utilize cutting edge technology to provide the patient with the best level of care for the right amount of time.

Why Is This Role Critical?

The Director, Actuarial Services will be a key Leader providing actuarial expertise by overseeing all risk based contracts through naviHealth’s Medicare Advantage and Bundled Payment lines of business. This role presents a unique opportunity for an Actuary to join the healthcare industry driving a Value Based Care model, by seeing the views of the payor as well as supporting operational decisions based on your analysis and risk evaluation. The Director will be instrumental in facilitating upfront conversations setting contract structure with external customers and partners, as well as seeing that the contract requirements are carried out by our operations and finance teams.

What you will be accountable for…

  • Provide analysis on whether internal and external projects, solutions or investments are likely to lower healthcare costs and to what degree
  • Participate with Business Development, Medical Integrity, Clinical, etc. Teams on initiatives to ensure appropriate and relevant healthcare cost and health economic factors are captured
  • Using mathematical modelling techniques and statistical concepts to determine probability and assess risks to price Medicare services
  • Responsible for development, oversight and reporting of Medicare cost impact models which include economic and statistical analyses
  • Responsible for incorporating metrics and benchmarks (both internal and external) in analyses to proactively identify and evaluate both leading and trailing indicators of Medicare costs that may affect economic and Medicare cost impact models
  • Partnering with Sales Team on product pricing, financial modeling and business/contract review of all business development activity.
  • Revenue forecasting overview
  • Cross functional projects with data science, clinical outcomes, and analytics.

What you will need to be successful…

  • ASA or near ASA
  • 5+ years of experience in the healthcare industry
  • Experience with health insurance products, including: Compliance and Filing, Rating, Product development, Underwriting and Business Development
  • Advanced knowledge of medical claims data
  • Well-organized with the ability to handle several projects/clients simultaneously
  • Well-developed oral and written communication skills
  • Risk adjustment and predictive modeling experience a plus

About Us

NaviHealth is a pioneer in care transitions with a combined unprecedented 18 years of experience that uniquely positions us to manage and share risk with our partners. As a Cardinal Health company, we provide clinical support alongside scaled technology and advisory solutions that empower health systems, health plans, and post acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes

naviHealth Values

We care about the people we serve.

We care about each other.

We care about our communities.

We embrace innovation.

We like simple.

naviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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Meet Patricia

My work is very analytical, and it’s very satisfying sifting through the layers of information to solve challenges. It can be time consuming, but that moment of finding what’s holding an order up is worth the effort. I also enjoy being a representative of Cardinal Health and building rapport and trust with our customers.
Patricia, Collections Coordinator