Associate Vice President, Finance - Budget, Treasury & Cash Management

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Occupational Summary:
The Associate Vice President – Budgets, Treasury and Cash Management is a strategic leadership role responsible for overseeing the development, implementation and management of the health system's financial planning, including annual operating and capital budgets and long-term financial plans, combined with strategic and operational treasury and cash management direction. This position ensures financial integrity, optimizes resource allocation, and supports the system's mission of delivering high-quality healthcare. The Associate Vice President collaborates closely with executive leadership, department heads, and key stakeholders to achieve fiscal goals while maintaining operational efficiency and sustainability.

The position will be responsible for day-to-day execution of operating and capital planning and budgeting and the DUHS treasury function.  The position will take the lead in the identification of risks and risk management processes related to cash and treasury management.  The position will have primary responsibility to establish and maintain integrated planning, budgeting and treasury accounting systems and policies across all operations and business units of DUHS, assuring the required high level of service from the University for shared functions is consistently achieved.  This is a highly visible position, and, therefore, requires a tremendous amount of effort to coordinate and lead multiple divisions of the Controller’s organization, while also providing direction to the University related to DUHS’ needs for shared services. The position will be responsible for overseeing recurring budget and long-term planning cycles, financial analysis, statistical and FTE reporting for budgets, Durham Casualty accounting, operations and reporting and multiple other finance and accounting functions.  

Work Performed:
I.    Budgets, Strategic Financial Planning and Capital 

Budget Strategy and Planning 
⦁    Lead the development, execution, and monitoring of the health system’s annual operating and capital budgets.
⦁    Collaborate with senior leadership to align budget strategies with organizational goals and long-term strategic plans.
⦁    Provide financial forecasting, modeling, and scenario analysis to support decision making processes.
⦁    Ensure budgetary compliance with regulatory requirements and internal financial policies.
⦁    Drive the full implementation and integration of STRATA technology for budgeting, planning and capital.

Financial Analysis and Reporting
⦁    Oversee the preparation of comprehensive financial reports, including variance analysis, performance metrics, and financial trends.
⦁    Present budget updates and financial performance insights to the Executive Team and Board of Directors.
⦁    Develop and implement key performance indicators (KPIs) to monitor financial health and operational efficiency.

Capital Expenditure Management
⦁    Direct the planning, evaluation, and approval process for capital investments, including facilities, equipment, and technology.
⦁    Ensure effective utilization and return on investment for capital expenditures.
⦁    Lead cross-functional teams in the prioritization and funding of capital projects.

Risk Management and Compliance
⦁    Identify and mitigate financial risks through effective budgetary controls and financial audits.
⦁    Ensure compliance with healthcare regulations, financial standards, and reporting requirements.
⦁    Maintain a high level of integrity and ethical standards in all financial activities.

Leadership Incentive Compensation Programs (Short Term Incentive (STI) and Long Term Incentive (LTI))
⦁    Responsible for all finance aspects of managing and reporting STI and LTI.

Reporting
⦁    Prepare Board presentations and reports for senior management using appropriate technology.
⦁    Ensure that all quarterly external debt compliance reporting (to Electronic Municipal Market Access – EMMA – database, rating agencies, bond trustee, NC-MCC, etc.) is completed accurately and delivered timely.
⦁    Ensure that all annual external financial reporting and debt compliance reporting is completed accurately and timely.
⦁    Maintain an up-to-date and anticipatory knowledge of upcoming accounting, compliance and financial reporting changes, to include: 1. Securities Exchange Commission (SEC) deliberations on municipal market regulation and reporting, and 2. Electronic Municipal Market Access (EMMA) Reporting.

Policies and Procedures
⦁    Review policies and procedures for Finance and Accounting functional areas to ensure consistency across DUHS business units
⦁    Ensure that business unit staff are educated and trained on DUHS Finance and Accounting policies and procedures
⦁    Evaluate and challenge the University’s accounting policies and procedures as necessary, to ensure that both organizations are exhibiting progressive accounting ideas and embracing necessary system changes

Corporate Treasury and Cash Management 
⦁    Debt Management and Accounting
⦁    Plan, manage and execute all DUHS external borrowing and tax-exempt bond offerings, including coordination of investment bankers, bond attorneys, rating agencies and N.C. governmental units.
⦁    Ensure adequate post-issuance internal controls over tax-exempt bond proceed use and the ultimate use of tax-exempt bond financed property.
⦁    Confirm all debt-related accounting, reporting, covenant testing, etc. is completed accurately and timely.
⦁    Ensure all weekly, monthly and annual accounting, reporting and payment activities are completed accurately and timely for DUHS variable rate, tax-exempt debt (all of which has been converted to direct placed bank debt since 2011).
⦁    Derivatives and Swap Management
⦁    Plan, manage and execute all DUHS debt derivative and interest rate swap transactions, including coordination of investment bankers, derivative attorneys, rating agencies, etc.
⦁    Cash Flow Projections and Reporting
⦁    Prepare daily cash and swap MTM reports.
⦁    Prepare and maintain weekly and monthly cash flow and working capital projections for DUHS.
⦁    Prepare monthly GAAP indirect-method and GL-based direct method cash flow reports for DUHS.
⦁    Ensure that DU Treasury provides adequate service levels and reasonable controls over the debt payment cycle.
⦁    Investment of DUHS Reserve Funds
⦁    Coordinate directly with DUMAC on the accounting and reporting for the DUHS single-owner investment pool (HSP) managed by DUMAC.
⦁    Provide liquidity and collateral management, working directly with DUMAC on DUHS treasury security and other transactions, including the Liquidity Management Account (LMA).

Management of Shared Services with DU
⦁    Responsible for ensuring that DU financial operations maintains adequate systems and appropriate internal controls to support DUHS’ required service levels for the following functions (as specified in the 1999 Operating Agreement):
⦁    Commercial Banking Relationships
⦁    Investment Management through DUMAC
⦁    Capital Acquisition and Repayment
⦁    Compliance with Credit Card Industry Privacy and Security Standards
⦁    N.C. Sales and Use Tax Computation, Remittance and Rebate
⦁    Establish and maintain “Service Level Agreements” to address customer service issues and develop service level performance measurement and internal control expectations between DUHS and Duke University

II.    Durham Casualty Company (DUHS’ Insurance Captive)
Responsible for the day-to-day coordination of essentially all Durham Casualty Company (DCC) transactions and activities to include:
⦁    Planning and execution of all DCC Board meetings (with Bermuda insurance managers)
⦁    Planning and execution of DCC’s annual external audit, GAAP financial reporting, and Bermuda statutory reporting
⦁    Coordination of premium cycle with external actuaries
⦁    Joint reporting of claims cycle with Clinical Risk Management
⦁    Coordination of investment cycle with DUMAC (funds managed by DUMAC)
⦁    Proper accounting for the reinsurance program, and coordination with broker as necessary
⦁    Completion and filing of all required DCC tax returns and tax reporting
⦁    Development of DCC annual budget (Note: DCC currently consists of approximately $350 million in assets.)

III.    DUMAC Finance
Meet with DUMAC – EVP and staff at least quarterly for updates on HSP, DCC, and other investment and cash flow planning items.  Duke University School of Medicine (SOM)
Partner with SOM “Chief Financial Officer” as needed on budgeting, accounting and finance issues that cross organizations.
(Note: Coordination is required at both the DU Corporate Finance level and at the DU-SOM level due to the decentralization of accounting decision-making within the University.)

IV.    General
⦁    Maintain application skills necessary for efficient data compilations and reporting.
⦁    Review work of direct reports and staff and assist in training of new employees.
⦁    Recommend various personnel actions, including hiring, performance appraisals, promotions, transfers, vacations schedules and other pertinent tasks.
⦁    Perform other related duties incidental to the work described herein.V.    Leadership and Collaboration
⦁    Lead, mentor, and develop the finance team, promoting a culture of accountability, collaboration, and continuous improvement.
⦁    Collaborate with clinical and administrative departments to understand financial needs, challenges, and opportunities.
⦁    Foster strategic partnerships with vendors, financial institutions, and regulatory agencies.

General Qualifications, Specific Skills and Education/Experience
General Qualifications:
⦁    A leadership style that will enable this person to direct, supervise, and unite accounting staff in the management of budgeting accounting and finance issues
⦁    Administrative and organizational skills to plan, organize and make commitments to the system leadership, accounting staff and external constituents.
⦁    Ability to work as a team player and partner with the DUHS Senior Vice President, CFO and Treasurer and Vice President, Finance to represent the department at Board, Compliance/Audit and Finance Committee meetings.
⦁    Solid understanding of generally accepted accounting principles, Federal Income Tax rules and regulations, Medicare, Medicaid, and third-party reimbursement, information systems applications for accounting and financial reporting.
⦁    Knowledge of preparing monthly/annual Financial Statements, external audits, State/Federal tax reports, General Ledger and capital/operating budgets
⦁    Strong analytical and strategic-thinking ability
⦁    Capable of focusing long-term, with an exceptional grasp of the details and a strong track record for follow-through
⦁    Confident, engaged, and innovative possessing high energy balanced with high integrity
⦁    Demonstrated ability in strategic and operational financial planning/management/reporting, critical thinking, system analysis, as well as quality and performance improvement processes related to a growing and dynamic organization
⦁    Demonstrated knowledge of today’s healthcare environment, change processes, organizational development, regulatory requirements, reimbursement, managed care, etc.
⦁    Comfortable leading change and the development of effective systems and processes, especially as they relate to systemization efforts

Experience:
⦁    Master's degree in Finance, Accounting, Business Administration, or a related field required; CPA or CFA certification preferred.
⦁    Minimum of 10-years of experience in financial management, with at least 5 years in a senior leadership role within the healthcare industry or healthcare consulting.
⦁    Demonstrated expertise in operational and capital budget planning, financial analysis, and strategic financial management.
⦁    Strong understanding of healthcare financial regulations, reimbursement methodologies, and industry trends.
⦁    Exceptional leadership, communication, and stakeholder management skills.
⦁    Proficiency in financial management systems and advanced analytical tools.
⦁    Strong PC skills in applications such as Outlook, Excel, Word, and other Microsoft applications are important, as well as the ability to perform in a high-pressure environment, meeting frequent deadlines under extended work hours.

Specific Skills:
⦁    Person who possesses a strong business orientation to assist the health system in achieving and maintaining ongoing financial viability.
⦁    Ability to build strong interpersonal relationships with accounting staff and management at all levels of the organization.
⦁    Strong communication skills.
⦁    Role model for fiscal and corporate integrity.

Key Competencies
⦁    Strategic Thinking and Financial Acumen
⦁    Leadership and Team Development
⦁    Analytical and Problem-Solving Skills
⦁    Excellent Communication and Presentation Skills
⦁    Adaptability and Change Management

Compliance Program
The Associate Vice President, Finance – Budgets, Treasury and Cash Management, will be required to adhere to all compliance policies and procedures and as well as inform all supervised staff of required compliance.  The Associate Vice President will be periodically trained in new elements of the Compliance Program, and performance will subsequently be evaluated in part according to adherence to compliance rules.

Supervision Responsibility
The Associate Vice President will be responsible for guiding and managing the performance of his/her direct reports and their staff in the Vice President – Finance’s organization.  This position will also assume primary responsibility for the internal communication flows during the budgeting, planning and capital cycles.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.