Budget and Pricing Manager
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Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.
The Budget and Pricing Manager will manage Part C CMS bid process for analysis and filing of Medicare premium rates, plan benefit summaries, and coordination of UCare's health care cost and utilization budget. Report the actual costs and utilization performance compared to budgeted levels on a quarterly based budgeted cost. Lead the health care exchange pricing and analysis to set benefit packages and premium levels. Assist in the analysis of new business opportunities as well as other ad-hoc financial reporting.
Specific duties and responsibilities include:
- Manage, develop, and monitor Financial Analysts to ensure accurate analyses are developed in support of UCare's overall business needs.
- Manage and coordinate the analysis, preparation, and filing of the Medicare premium rates and benefit package proposals for Part C. Develop and maintain process to develop and file Medicare premium rates under the Medicare Advantage bidding process and work in collaboration with the annual Medicare Part D bidding process. Ensure thorough process documentation is maintained to meet CMS audit requirements. Work closely with third party actuarial firm(s) to obtain an actuarial certification for CMS bids and filings. Establish and maintain relationships with CMS staff as it relates to bidding and bid negotiation.
- Manage and coordinate the development of Federal filing of MSHO bid projections and filings ensuring consistency with state filings and Medicare coverage.
- Manage and coordinate the development and filing the health care exchange projections as required by federal and state regulation and other product pricing as needed.
- Lead the annual production of the UCare health care cost, revenue, and utilization budget projections. Maintain and update budget models as necessary. Work closely with PMD, Clinical Services, PNM, Marketing, Sales, and Accounting to coordinate and verify accuracy of the overall budget documentation.
- Work closely with Managers and stakeholders from Government Programs, PMD, and Sales area to develop benefit summary documents (PBPs) that correspond to product pricing and federal bid filings.
- Maintain familiarity with competing product benefit packages and premium structure. Participate in the development of pricing and benefit strategy for new and existing product lines. Assist in analysis of expansion and other business opportunities.
- Manage and coordinate the process for setting employer group Medicare premium rates. Ensure pricing follows CMS group pricing guidelines. Work with Sales to develop pricing documents to be presented to employer groups.
- Coordinate the production of a quarterly budget to actual report to be presented to Senior Management.
- Coordinate with other Health Care Economics staff to obtain necessary information for major projects such as the UCare budget and product pricing.
- Serve as Health Care Economics representative on various ad-hoc work groups. Provide ad-hoc financial analysis as needed.
A Bachelor's degree with an emphasis in finance/accounting/economics is required. A minimum of six years related experience in an Actuarial or Finance; HMO or insurance industry experience is also required.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.