Job Description
Nemours is seeking Director, Global Budget Program. The Director, Global Budget Program is a key enterprise leader responsible for leading Nemours' system-wide implementation of global budget towards successful financial sustainability and quality metrics. This role leads the Global Budget Program, overseeing the execution, governance, and scaling of Nemours first global budget Medicaid Revenue models across Nemours' Delaware Valley and Florida markets.
This position provides strategic oversight of financial sustainability initiatives, total cost of care (TCOC) methodologies, and reimbursement innovation, ensuring that Nemours' Pay-for-Health strategy is structurally embedded across global revenue budget, shared risk arrangements, and whole child health strategy. The Director leads Nemours' engagement with state Medicaid agencies, commercial payers, and regulatory bodies, ensuring enterprise-wide risk management and contract alignment for long-term sustainability.
The Director operates at the intersection of finance, actuarial modeling, population health, and clinical operations, ensuring alignment between Nemours' financial sustainability strategy and its Whole Child Health Strategy (WCHS). This position is responsible for Nemours' global revenue budget transformation roadmap and supporting alignment strategies to transition Nemours into an industry leader in pediatric whole child health pay-for-health strategies.
This role requires deep expertise in financial modeling, alternative payment methodologies, risk adjustment, and payer engagement, as well as technical proficiency in actuarial analysis, total cost of care benchmarking, and enterprise financial forecasting. With a matrixed, cross-functional scope, this role demands effective communication skills, the ability to handle ambiguity, and a proactive approach to defining and executing analytic priorities in collaboration with others. The Director reports to the VP, Chief Policy and Prevention Officer.
Essential Functions: - Strategy & Integration - Serves as a leading support to the Chief Population Health Officer and Chief Policy and Prevention Officer, supporting them and increasing their bandwidth to execute on the payment innovations to support whole child health aligning across population health, clinical services, and financial sustainability. Drives cross-functional strategic planning and execution of Pay-for-Health initiatives related to global budget. Supports Nemours' Population Health Leadership for board-level discussions on financial sustainability, reimbursement transformation, and pediatric payment innovation. Facilitates enterprise-wide collaboration to integrate care delivery, financing, and risk-sharing models, positioning Nemours as a leader in pediatric accountable care.
- Direct, Manage and Implement - Directs the Global Budget Program, ensuring seamless and compliant execution with Delaware DMMA, MCOs, and internal stakeholders. Oversees baseline revenue setting, mid-year adjustments for case mix, service volumes, and policy changes, and year-end financial reconciliation. Coordinates cross-functional teams to monitor performance, manage retained savings allocation, and align financial outcomes with cost efficiency, quality targets, and population health objectives. Leads the financial oversight, reconciliation, and ongoing evaluation of the Delaware Valley Global Revenue Budget (DV GRB), ensuring that financial outcomes are aligned with policy objectives, cost efficiency, and health equity. Implements processes for ongoing performance monitoring, integration and ongoing planning. Manages vendor partnerships and consultant engagements, ensuring execution of risk-based and value-driven reimbursement strategies.
- Governance: Facilitates enterprise-wide governance structure, financial oversight, and executive reporting mechanisms to ensure cohesion in payment transformation. Establishes a cross-functional payment strategy framework, ensuring that actuarial, financial, and clinical teams remain aligned with Nemours' system-wide APM adoption. Supports and staffs the Enterprise Payment Integration Committee, a cross-functional governance structure with the CPHO, CFO, and COO, and other stakeholders, ensuring strategic alignment and advancing opportunities to scale and operationalize additional risk-based reimbursement models.
- Collaboration: Builds and executes multi-market expansion plans for Nemours' payment model innovation strategy based on leadership direction. Leverages relationships with Nemours state and federal affairs teams to engage with state Medicaid leadership, federal regulatory bodies, and external actuaries to ensure financial sustainability and operational feasibility of all payment model innovations.
- Communication and Thought Leadership: Staffs Nemours leadership in industry-wide discussions on alternative payment models, value-based pediatric reimbursement, and total cost of care reform. Provides support for leadership to engage in HCP-LAN policy discussions, industry working groups, and national payment reform summits to drive Nemours' influence in shaping the future of value-based pediatric care.
- Coaching and Mentoring - Builds and leads Enterprise Global Budget work, supporting a high-performing team to drive system-wide payment transformation. Oversees budgeting, financial management, workforce management, and associate development while modeling Nemours corporate values and alignment with system objectives and compliance expectations.
- Other duties as assigned and necessary.
Job Requirements: Advanced Degree in healthcare management, health policy, medical economics, hospital finance, or related fields.
More than 5 years of job related experience required.
Experience in financial modeling, alternative payment methodologies, risk adjustment, payer engagement, technical proficiency in actuarial analysis, total cost of care benchmarking, and enterprise financial forecasting
Job Tags
Permanent employment, Contract work,