VP Medicaid Markets CEO - PA

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job leads the overall performance of a Medicaid plan, for quality of care and service as well as financial performance. The incumbent delivers the revenue and operating gains for this market. They are accountable for establishing and maintaining strategic relationships within the assigned state, the care provider partners, key vendors, and the community at-large. The incumbent develops the strategic direction and insurers it’s execution for revenue management, federal and state regulatory and contract compliance, care management, and service to all key constituents through direct and indirect reporting relationships with the CMO, COO, CFO and Chief Compliance Officer as well as other key business partners. The incumbent provides strategic direction and management oversight of staff performing the core functions which are provided through administrative services agreement.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority
• Develop strategic goals and business plans to be executed at the health plan. Collaborate on the development and oversee implementation and reporting of the annual short- and long-term strategic business plan, budget, and financial projections to include all reporting required by local, state, and federal officials/ agencies.
• Work with Actuary, Finance, Executive Leadership and key business partners, lead the state contract RFP or rate renewal activities to ensure the acquisition, retention, and profitability of the business. Tasks include facilitating the proposal or rate renewal process, preparing rate proposals and related materials for executive leadership review/approval and for submission to the state, and serving as business lead in negotiations with the state.
• Develop and maintain mutually beneficial relationships with key elected officials, key community organizations and other influential local entities in support of the state's Medicaid programs and members as well as market and community goals. Stay current with federal and state health care reform, legislative and regulatory activities and proposed changes, assessing impacts, advising Highmark's public and private positions and engaging as needed to shape regulatory and contract outcomes.
• Develop and maintain positive, mutually beneficial relationships with strategic provider partners within the market. Partner with and provide both strategic and tactical direction to the provider network contracting team to build and enhance the provider network and related vendors to achieve the care, service and financial goals. As needed, engage in provider relations escalated service issues to achieve high provider satisfaction and deliver quality care to members.
• Work with Highmark Compliance, provide strategic direction and tactic guidance to the compliance programs and practices to ensure full compliance to federal/state regulations and contract terms and conditions. In coordination with Highmark Compliance, provide business leadership to all compliance reviews, such as ERQ and ISCA, as well as other external organizations such as BCBSA and NCQA.
• Lead and manage the team and organization to execute our care and service commitments to our key constituents with a primary focus on serving and caring for our members. Work to continuously improve the health plans performance, minimize performance risks, and engage in escalated issues to achieve mutually satisfactory outcomes, with a focus on membership care and satisfaction.

EDUCATION

Required

• Bachelor's Degree in Business Administration/Management

Substitutions

• None

Preferred

• Master's Degree in Government

EXPERIENCE

Required

• 10 years of Medicaid Experience
• 10 years in Management

Preferred

• None

LICENSES OR CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Financial Risk Management
• Government Programs
• Sales
• Communication Skills
• Presentation Delivery
• Business Strategy
• Collaboration
• Managed Care 

Languages (other the English)

None

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