Job Description

About this role

Work Culture: GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s Core Values

• Integrity
• Accountability
• Collaboration
• Trust
• Respect

Disclaimers

• Flexible work schedule is based on job duties, department, organization, or business need.
• Gold Coast Health Plan will not sponsor applicants for work visas.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodation may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

Financial Strategy & Leadership

• Develop and execute the organization’s financial strategy aligned with corporate goals
• Advise the CEO, Executive Team, and Commission on financial performance, risks, and opportunities
• Lead long-term financial planning, capital allocation, forecasting, timely reporting and growth initiatives (e.g., expansion of Medi-Cal or Medicare Advantage lines)

Financial Operations

• Oversee budgeting, forecasting, and financial reporting processes
• Ensure accuracy and timeliness of monthly, quarterly, and annual financial statements
• Manage cash flow, investments, and capital structure
• Optimize administrative and medical cost structures (MLR management)

Regulatory Compliance (California Focus)

• Ensure compliance with California regulatory standards in alignment with Chief of Compliance
• Oversee statutory reporting, rate filings, and financial audits in collaboration with Department of Enterprise Analytics and Insights
• Maintain compliance with federal programs (Medicaid Medicare)

Risk Management & Controls

• Establish and maintain strong internal controls and financial governance frameworks
• Oversee departmental alignment with organizational risk management, including underwriting and actuarial coordination
• Ensure solvency, reserves, and Risk-Based Capital (RBC) requirements are met

Provider & Payment Strategy

• Partner with provider network operations and actuarial teams on provider reimbursement models (capitation, value-based care)
• Monitor and report on utilization trends and medical cost drivers
• Support contract negotiations with providers and vendors

Team Leadership

• Lead finance, accounting, FP&A, and potentially actuarial functions
• Build and mentor a high-performing finance organization
• Foster cross-functional collaboration across operations, clinical, and network teams

MINIMUM QUALIFICATIONS

• Education & Experience: Bachelor's Degree (four-year college or technical school), Field of Study: Finance or CPA Highly Desirable.
• 15+ years of progressive financial leadership, with at least 9+ years in a senior executive role (CFO, VP Finance) within a California health plan or managed care organization.
• Deep operational knowledge of healthcare reimbursement models and insurance principles
• Demonstrated leadership excellence complemented by highly developed executive-level communication skills
• Mastery of California-specific regulations (HCAI, DHCS, DMHC) and Federal healthcare regulatory environment (CMS/HHS)
• Familiarity with capitation, fee for service, risk adjustment, actuarial processes, and value-based care models
• Executive-level experience in a managed care, public health, or safety-net setting i.e. Medi-Cal managed care and/or Medicare Advantage
• Experience managing the financial complexities of Pharmacy Benefit Management, including rebate structures and specialty drug spend.
• High level of integrity and dependability with a strong sense of urgency and results-orientation.
• Proven success leading to enterprise-wide transformation or complex delivery systems
• Executive presence and advocacy skills
• Expertise in organizational culture, change management, and leadership development

Preferred Qualifications

Master’s Degree, Field of Study: MBA, Health/Hospital Administration, Public Health, or Business Administration, or related field.

Technology & Software Skills

• Advanced computer skills in MS Office products to include proficiency with Workday and Adaptive

Licenses & Certifications

• A valid and current Driver's License, Auto Insurance, and professional licensure(s)

Competency Statements

• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
• Systems Analysis - Ability to determine how a system should work and how changes in conditions, operations, and the environment will affect outcomes.
• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.
• Ethical Stewardship: Proven accountability with unwavering fiscal and moral integrity with a commitment to public-sector transparency.
• Technical Excellence: Expertise with regulatory and compliance, financial modeling, analytics, and data-driven decision-making
• Strategic Communication: Ability to translate complex financial data into actionable insights for non-financial stakeholders and public commissions.
• Decisive Leadership: A track record of building, mentoring, and retaining high-performance finance and actuarial teams.
• Presentation Skills - Ability to effectively present information publicly.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
• Financial Aptitude - Ability to understand and explain economic and accounting information, prepare and manage budgets, and make sound long-term investment decisions.

Work Environment & Requirements

• Based in Southern California this is a hybrid role requiring on-site presence based on organizational needs and direction from leadership.
• Will require highly collaborative interaction with state and federal regulators and mandatory in-person attendance at monthly Commission meetings.

PHYSICAL DEMANDS

• Activity is not applicable to this position.
• Position requires this activity up to 33% of the time (0 - 2.5+ hrs/day).
• Position requires this activity from 33% - 66% of the time (2.5 - 5.5+ hrs/day).
• Position requires this activity more than 66% of the time (5.5+ hrs/day).
• Stand – Lift/Carry 10 lbs or less.
• Walk (11–20 lbs).
• Sit (21–50 lbs)
• Manually Manipulate (51–100 lbs).
• Reach Outward (up to 100 lbs).
• Reach Above Shoulder (occasionally).
• Climb Crawl (never).
• Push/Pull 12 lbs or less (occasionally).
• Squat or Kneel (26–40 lbs).
• Bend – 41–100 lbs.
• Grasp – Speak (frequently).
• Other Physical Requirements – Vision (Near, Distance, Color, Peripheral, Depth).

WORK ENVIRONMENT

Office environment.

Pay Range

The estimated pay range for the position is: $258,750.00 - $431,250.00. The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

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