Chief Financial Officer - Association for Community Affiliated Plans : Job Details

The Chief Financial Officer (CFO) is responsible for the financial management of the organization to include premium rate development, actuarial services, directed payments, budget analysis/management, financial modeling and reporting, cost benefit analysis, capitation development, claim operations, forecasting needs, facilities, payroll, accounting/treasury operations, internal auditing, risk insurance management, and purchasing including the procurement process.

In addition to providing financial leadership for IEHP, this position will be responsible for actuarial planning, forecasting, and analysis of financial/organizational risk associated with Medi-Cal, Covered California, and Medicare CCI Dual lines of business. The CFO will offer quality, meaningful analyses, and financial perspectives necessary for organizational decisions and strategic/operational planning. The CFO is also responsible for the following non-financial departments – Claims, Property Management, Facilities, Business Continuity, Medical Economics, and Risk Score Management for Medi-Cal, Covered California, and DSNP products.

Responsibilities:

• Oversees and directs budgeting, financial audits, MCO tax, accounting, capitation, purchasing, premium rate development with the DHCS, Covered California, and CMS, procurement of capital equipment, services and supplies, long-range forecasting, risk insurance management activities, recovery of claim overpayments, financial auditing of IPAs and vendors, internal audit, and treasury for IEHP.
• Manages staff to develop and implement procedures and computer application systems necessary to maintain proper records and to afford adequate accounting controls and services.
• Ensures staff is engaged, well informed, and aligned with organizational priorities through clear communication, ongoing coaching, and professional development opportunities.
• Provides strategic leadership and insights into IEHP's business lines while actively partnering with executive leaders to drive alignment, inform decision making, and ensure financial sustainability across the organization.
• Oversees production of monthly comprehensive financial and actuarial reports.
• Coordinates treasury activities such as custodian of funds and IEHP's assets.
• Appraises IEHP's financial position and issues periodic reports on the organization's financial stability, liquidity, and growth.
• Develops the annual operating and capital budgets.
• Analyzes, consolidates, and directs all cost accounting procedures together with other statistical and routine reports.
• Oversees and directs the preparation and issuance of the annual audit.

The ideal candidate will bring deep expertise in Medi-Cal/Medicaid health plan finance, with a strong understanding of the rate setting process and a demonstrated ability to collaborate effectively with state partners. This individual must be a strategic thinker who asks insightful questions, anticipates challenges and quickly identifies issues. A broad understanding of the health plan landscape along with a disciplined, data-informed approach to budgeting and performance monitoring is critical to this role.

The CFO will be an experienced and engaging leader who is passionate about mentoring and developing teams. Strong interpersonal skills and a collaborative style are ideal attributes as the CFO will work closely with leaders across the organization and build trusted relationships with internal and external stakeholders. The CFO will act as an advocate for the health plan with regulatory bodies and external partners. This individual must thrive in a collaborative, service-oriented culture that values transparency, genuine partnership and community impact.

Staff:Direct reports include Vice President, Finance; Vice President, Actuarial Services; Vice President, Property Management & Development; Senior Director, Claims; Director, Procurement & Supply Chain; Executive Assistant; total staff of 524.

Experience/Knowledge Requirements:

• Ten (10) years of experience in finance/accounting with a minimum of five (5) years of experience in a managed care environment, and a minimum of five (5) years of staff management experience.
• Experience with Medi-Cal or Medicaid is required and existing Medi-Cal experience and relationships with DHCS are preferred.
• The financial aspects of a managed care health plan, including finance, accounting, capitation, fee-for-service, procurement process, actuarial support, claim overpayments, internal auditing, risk pools, Rate Development Template (RDT)/Directed Payment Program (DPP), risk corridors, and MLR requirements.

Educational Requirements:

• Bachelor's degree in Finance or related field is required.
• Master's degree in a relevant financial field from an accredited institution is preferred.

Salary range:A reasonable starting salary expectation is between $517,213 – $603,408, based upon related/relevant experience and internal equity.

Meaningful Interest Points About Rancho Cucamonga:

The centralized location of the town is one of the best perks, no matter where you are heading out to! From Rancho Cucamonga, you can get to San Diego in less than two hours, Palms Springs in just slightly above an hour, and Los Angeles in only 45 minutes by car. The town isn't only close to major cities, but you can easily access beaches and mountains from here.

If you or someone you know has the qualifications for this role, I would love to set up a time to talk. Thank you so much for your time.

• Directs and analyzes studies of general economic, business, and financial conditions and their impact on the organization's policies and operations.
• Analyzes trends in expenses to reveal outliers and assist with analysis of potential causes.
• Reports on financial status monthly at Governing Board meeting.
• Analyzes financial issues impacting operational areas and the entire organization and recommends appropriate activities to ensure cost efficiency.
• Oversees the rate development process with Medi-Cal and CMS; develops and maintains collaborative relationships with DHCS, Covered California, and CMS to ensure credibility and influence with rate-setting leadership.
• Final Reviewer and Signatory for all provider contracts and administrative contracts.
• Oversees Large Actuarial Department involved in provider analytics, IBNR, fee schedule analysis, risk score accuracy for Medi-Cal, DSNP, and Covered California.
• Oversees Claims Production and vendor oversight for all lines of business.
• Builds effective relationships with the provider community to align financial strategies, support value based care, and maintain trust through transparency and partnership.
• Oversees Property Management & Development including Facilities and Business Continuity of IEHP's property portfolio including property management; maintain and enhance the value of commercial and real estate assets to optimize IEHP's financial return.
• Oversees Provider Data Configuration system configurations and integrations related to provider data design and management and financial technical support related to claims and encounter data.
• Oversees Product System Configuration activities related to the development and implementation of IEHP benefit and product system configuration and related system integrations; includes the development of enhanced system.
• Oversees cross-functional benefit implementation and clinical procedure code changes from Medi-Cal, Medicare, and commercial products (Covered CA) and its underlying code sets impacting claims payments.
• Oversees risk adjustment data validations and enforcing coding standards based on guidelines provided by CMS for risk adjustment.
• Oversees risk coding workflows for risk adjustment models and risk revenue management for Medi-Cal, ACA products and Covered CA products.
• CEO delegate for reviewing and signing all provider contracts and administrative contracts throughout the company.
• Builds strong relationships with key DHCS stakeholders, public hospitals, and Board of Supervisors.
• Provides oversight of actuarial activities including premium analysis, cost trends, IBNR development, and risk management.
• Ensures internal audits, proper controls, and procedures exist to protect the financial and operational interests of IEHP.
• Provides guidance and leadership for the Medical Economics Team.
• Strongly supports and assists with FWA efforts throughout the plan.

Professional Licenses:CPA is preferred.

Knowledge:The financial aspects of a managed care health plan, including finance, accounting, capitation, fee-for-service, procurement process, actuarial support, claim overpayments, internal auditing, risk pools, Rate Development Template (RDT)/Directed Payment Program (DPP), risk corridors, and MLR requirements.

Commitment to Team Culture:The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

The position purpose, principal accountabilities, essential functions, minimum qualifications and the requirements listed in this position description are representative only and are not exhaustive of the tasks that a Team Member may be required to perform. IEHP reserves the right to revise this job description at any time, and to require Team Members to perform other tasks as circumstances or conditions of its business considerations or work environment change.

Oversees Provider Data Configuration system configurations and integrations related to provider data design and management and financial technical support related to claims and encounter data.Oversees Product System Configuration activities related to the development and implementation of IEHP benefit and product system configuration and related system integrations; includes the development of enhanced system.Oversees cross-functional benefit implementation and clinical procedure code changes from Medi-Cal, Medicare, and commercial products (Covered CA) and its underlying code sets impacting claims payments.Oversees risk adjustment data validations and enforcing coding standards based on guidelines provided by CMS for risk adjustment.