CalOptima is a county organized health system that administers publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. With $3.4 billion in annual revenue, CalOptima serves nearly 800,000 members, delivering services through 14 health networks. For the past three years, CalOptima has been rated the top quality Medi-Cal plan in California, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2016–2017.
Manages CalOptima’s overall financial operations, including budgeting, financial planning and analysis, finance and accounting, purchasing, investment management, and monitoring of health network financial compliance. Establishes financial policies and procedures as appropriate, provides financial strategic management, and deploys the financial assets of CalOptima to the optimum benefit of members, providers and taxpayers.
Bachelor’s degree in Accounting, Finance, Business, or related field is required. Master’s degree is preferred.
Active CPA certification preferred.
Progressively responsible experience within health care service delivery and/or managed care required.
Experience with capitation, pay for performance, risk sharing, and provider contracts required.
Experience with actuarial-based rate setting methodologies, state and federal contracts, and regulatory audits required.
Experience with Medicaid, Medicare, and/or commercial lines of business required.
Experience with functions such as IBNR, annual budget, reinsurance, and payroll required.
Public agency experience preferred.
CalOptima’s CFO must work to:
Establish policies that will ensure the fiscal integrity of CalOptima.
Serve as a member of CalOptima’s Investment Advisory Committee (“IAC”).
Manage cash flows and invest surplus funds to CalOptima’s best advantage and in accordance with CalOptima’s Annual Investment Policy.
Monitor and direct financial plans, including actuarial projections of capitation rates received, capitation rates paid, and incurred but not reported (“IBNR”) liabilities associated with medical claims.
Participate in the strategic planning process.
Oversee the preparation of CalOptima’s annual budget, present it to the Board of Directors, and ensure monthly compliance and/or appropriate documentation and explanation of variances from budget.
Establish and maintain bank accounts, financial controls, and business relationships required to properly administer the various financial functions of CalOptima.
Maintain adequate insurance and reinsurance coverage.
Participate in formulating, receiving and approving CalOptima’s plans and objectives.
Prepare monthly financial reports for CalOptima’s Board of Directors and the Finance Committee.
Oversee health plan and provider financial audit and compliance activities as they relate to financial reporting, payment of provider capitation, and payment of provider medical claims.
Ensure the development, implementation and adherence to financial procurement policies that meet CalOptima’s performance needs and ensure the appropriate commitment of funds.
Other projects and duties as assigned.
CalOptima’s CFO must have the ability to:
Lead investment management activities.
Quickly understand proposed rate structures.
Integrate financial, operational and medical management activities to achieve performance improvements.
Think strategically and implement immediately.
Provide sound fiscal leadership while supporting organizational growth and improvement.
Develop traditional business banking functions and investment policies.
Develop necessary financial strategies, budgets and fiscal monitoring to ensure the overall fiscal integrity of a publicly financed agency.
Analyze the need for and develop supporting proposals for any necessary federal waiver or changes in State policies or legislation.
Establish a sound program of insurance and reinsurance to protect the fiscal integrity of the program.
Oversee all applicable tax and regulatory compliance activities.
Communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
Prepare clear, comprehensive written and oral reports and materials.
Encourage the professional performance and development of subordinate staff.
Effectively utilize a personal computer and appropriate software and interact as needed with CalOptima Information Systems.
For a complete job description and to apply online, please go to www.caloptima.org. Questions can be directed to Debbie Neal, Senior Recruiter, 657-235-6981 or email@example.com.
Better. Together.Our mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. CalOptima is a county organized health system that administers health insurance programs for low-income children, adults, seniors and people with disabilities in Orange County.As Orange County’s largest health insurer, we provide coverage through f...our major programs:**Medi-Cal (California's Medicaid Program) for low-income children, adults, seniors and people with disabilities , seniors and persons with disabilities**OneCare (HMO SNP) (a Medicare Advantage Special Needs Plan) for low-income seniors and people with disabilities who qualify for both Medicare and Medi-Caldisabilities who qualify for both Medicare and Medi-Cal**PACE (Program of All-Inclusive Care for the Elderly) for older adults, providing comprehensive health services through the CalOptima PACE center**OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) for people who qualify for both Medicare and Medi-Cal, combining Medicare and Medi-Cal benefits, adding supplemental benefits for vision, transportation and dental services, and providing comprehensive care coordination“Better. Together.” is our motto, but it’s also our philosophy. We believe that by working together, we can make things better – for our members and community.