Chief Financial Officer (CFO)
Location: Ontario, CA (Hybrid – approx. 3 days onsite)
Employment Type: Full-Time, Senior Executive
Salary Range: $225,000 – $275,000
About the Opportunity
We are seeking an experienced and forward-thinking Chief Financial Officer to guide the financial strategy and long-term stability of a growing Medicare Advantage health organization. This executive will serve as a key advisor to the CEO, executive team, and Board of Directors, shaping the company’s direction through data-driven insights, strong financial stewardship, and regulatory expertise.
The CFO will oversee all core financial functions including accounting, finance operations, audit, budgeting, forecasting, risk management, treasury, procurement, reporting, and investor relations. This role is central to ensuring compliance, solvency, and readiness for continued expansion.
Key Responsibilities:
1. Medicare Advantage Financial Strategy
- Direct financial operations for Medicare Advantage plans, including premium revenue analysis, CMS reconciliation, medical expense forecasting, and IBNR.
- Lead or co-lead the financial components of annual Part C & D bids in collaboration with actuarial partners.
- Monitor and optimize RAF/HCC revenue performance, risk adjustment accuracy, and encounter-based financial analytics.
- Maintain cost-of-care forecasting and related financial insights.
2. Regulatory & Compliance Oversight
- Ensure adherence to CMS, DMHC, NAIC, and Knox-Keene financial regulations.
- Lead solvency planning including TNE, restricted cash requirements, and statutory filings.
- Oversee all mandated submissions such as MLR, PDE, DIR, FSR, and other federal/state reports.
- Manage quarterly and annual regulatory audits and financial statements.
3. Accounting, Reporting & Internal Controls
- Oversee accurate and timely GAAP and statutory financial statements.
- Strengthen internal controls related to claims, capitation, pharmacy, and delegated payments.
- Direct accounting functions including reserve management, reconciliation, and monthly close.
- Ensure systems and processes scale efficiently and support audit readiness.
4. Partnership With Actuarial & Cost Management Teams
- Collaborate closely with actuarial partners on trends, projections, and scenario modeling.
- Assess and structure risk-sharing, capitation, and other provider contracting models.
- Support certification processes and cost-containment programs.
5. Pharmacy & Part D Financial Management
- Lead pharmacy-related financial activities including rebate reconciliation, DIR forecasting, and PBM performance.
- Work with PBM partners on formulary strategies, MTM considerations, and unit cost optimization.
6. Vendor & Delegated Entity Oversight
- Provide financial governance for TPAs, PBMs, IPAs/MSOs, and all Financially Responsible Delegates.
- Lead audits of delegated partners and ensure alignment with CMS delegation requirements.
- Track capitation accuracy, shared-risk arrangements, and performance guarantees.
7. Treasury, Liquidity & Capital Planning
- Maintain liquidity to support claims, capitation, reinsurance, and new market readiness.
- Manage banking relationships, investment programs, and working capital.
- Support multiyear financial planning and market expansion initiatives.
8. Data, Analytics & Reporting
- Build advanced financial dashboards, predictive models, RAF/Stars reporting, and cost-of-care tools.
- Partner with IT and operations teams to enhance data quality and automate reporting workflows.
9. Executive Leadership & Board Communication
- Present financial reports, risk assessments, and solvency updates to the Board and executive committees.
- Translate complex Medicare Advantage financial concepts for cross-functional leaders.
- Develop and lead a high-performing finance organization capable of supporting growth.
10. Market Entry & New Plan Launch Readiness
- Lead financial preparation for CMS applications, DMHC submissions, and other market-entry requirements.
- Support PBM onboarding, TPA implementation, and provider contracting economics.
- Partner across departments to ensure operational readiness for expansion.
Qualifications:
Required
- Bachelor’s degree in Finance, Accounting, Business, or a related discipline.
- 10–15 years of progressive financial leadership experience, including at least 5 years in a senior finance executive role.
- Proven ability to develop financial strategies that improve profitability, operations, and long-term growth.
- Experience with financial software and ERP systems (QuickBooks, Oracle, SAP, etc.) and BI/reporting tools.
Preferred
- MBA, CPA, CMA, or CFA.
- Background in capital markets, investor relations, and regulatory filings (SEC experience a plus).
- Strong proficiency in Microsoft Office applications.
Key Attributes:
- Inspiring leadership and team-building ability.
- Strong analytical and problem-solving skills.
- Excellent communication skills with the ability to simplify complex topics.
- High integrity, transparency, and commitment to strong governance.
- Ability to work independently and in cross-functional settings.
- Detail-oriented with excellent organizational and prioritization skills.
- Capacity to thrive in a fast-paced, evolving environment.
Schedule & Work Expectations
- Standard business hours.
- As a growing organization, occasional evening or weekend work may be required for urgent priorities.
- Hybrid schedule—approximately 3 days onsite weekly plus in-person meetings with partners, vendors, and leadership groups.
Why Join
- Opportunity to shape the financial infrastructure of an expanding, physician-aligned Medicare Advantage organization.
- Play a central role in building a mission-driven health plan focused on seniors and community-centered care.
- Work within a strong local provider ecosystem supported by a publicly traded parent company with deep regional roots.
- Help drive long-term growth, operational excellence, and transformative healthcare initiatives.
