MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models. 

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Title: Director of Finance  

Location: Fountain Valley, CA

Department: General Accounting

Status: Full-time

Shift: Days

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. MemorialCare stands for excellence in healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

The Director of Finance leads financial planning, reporting, accounting oversight, and financial controls for MemorialCare Select Health Plan. The Director ensures accurate, timely financial and operational information for leadership, corporate finance, health plan partners, auditors, and regulators. The position also oversees data management and encounter data operations, including the integrity of claims and encounter data, reporting, submissions, issue resolution, and process improvement. The Director manages staff and coordinates across Finance, Operations, Information Technology, Quality, Utilization Management, and external partners.

• Lead the monthly close and review financial results, accruals, claims and capitation liabilities, premium receipts, vendor payments, and other material transactions. Ensure appropriate accounting treatment, reconciliations, supporting documentation, and timely correction of errors.
• Develop budgets, forecasts, financial plans, key performance indicators, medical expense analyses, and actionable presentations. Explain variances and trends to leadership and recommend responses to emerging risks or opportunities.
• Oversee preparation and timely submission of required monthly, quarterly, and annual financial reports to the Department of Managed Health Care and other applicable entities.  Coordinate the annual external financial statement audit (currently performed by PwC), regulatory examinations, actuarial work, and related requests for supporting documentation and remediation activities.
• Direct managed care analytics and reporting, including data extracts and queries, recurring leadership and joint operating meeting packages, ad hoc analysis, support for modeling, and analysis of medical expense fluctuations. Establish review steps that verify the completeness, accuracy, consistency, and timeliness of reported information.
• Oversee the encounter data function from intake through submission, acceptance, reconciliation, correction, and resubmission. Monitor claim and encounter volume, submission performance, data quality, and consistency with source systems and other reports; resolve discrepancies with staff, IT, clearinghouses, plan partners, and trading partners.
• Ensure encounter data processes reflect applicable Medi-Cal and Medicare reporting requirements, code sets, file specifications, and trading partner requirements. Oversee file mapping, testing, enhancement projects, audit work, and encounter reporting, including quarterly reports and annual HEDIS Roadmap support where applicable.
• Lead cross-functional improvements to claims, encounter, eligibility, payment, and reporting workflows. Document procedures and controls; assign ownership, test changes, monitor implementation, and train backup staff to support continuity.
• Manage Finance and assigned analytics and encounter data staff through clear priorities, coaching, performance reviews, succession planning, and workload oversight. Promote confidentiality and compliance with organizational policies.
• Prepared weekly High Dollar Report analysis/trending.
• Remains actively engaged in claims operations, critically evaluates the claims processing vendor’s performance; contributes meaningfully to monthly claims JOC meetings.
• Collaborate and work closely with CMO concerning medical expense trends, outliers, claims processing and report requests.

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications:

• At least five years of progressive finance experience in a managed health care organization, including financial reporting, planning, and analysis; experience leading staff and cross-functional work preferred.
• Strong knowledge of generally accepted accounting principles, managed care financial operations, claims and capitation, provider arrangements, and financial controls.
• Working knowledge of encounter data reporting, claims and enrollment data, health care code sets, and applicable Medi-Cal and Medicare requirements; ability to direct specialized staff and evaluate data quality and submission results.
• Advanced analytical and communication skills, including Excel and presentation tools; familiarity with enterprise accounting, health plan, database, and reporting systems. Ability to translate complex information into clear conclusions and action plans.

Education/Licensure/Certification:

• Bachelor’s degree in accounting, finance, business administration, or a related field required; master’s degree or relevant professional certification preferred.