Accountable for the development and overall performance of the Medicaid line of business for the Kaiser Permanente Mid-Atlantic States (KPMAS) region, with a focus on financial performance and membership growth. Oversees all aspects of Medicaid programs, contracting arrangements, product development, compliance with State and Federal Policies and requirements, partnerships with MAPMG, Administration, Program Office, and Provider Advisory Group. Strategically builds, manages, and sustains external business relationships, particularly with state and local regulators. Accountable for product development, administrative processes, interdepartmental communication, and regulatory requirements. Represents MAS region on KP National Medicaid Program activities. Develops an annual strategic plan and updates Executive Sponsorship on strategic issues/developments, business performance, and progress against objectives. Demonstrated passion and creativity in developing models of care serving low income, vulnerable populations.
+ Strategy and Innovation: Position region as the leader for quality, care delivery for high need vulnerable populations. The incumbent is accountable for customer experience achieves membership growth targets; developing and executing regional Medicaid strategy based on CMS requirements, national standards and alignment with overall national and regional strategy; Incorporates care delivery requirements into strategy and develops a strong partnership with medical group and health plan delivery system operations and quality; Demonstrated strategic thinking with ability to balance long-term direction with need for immediate impact and results; Maintain awareness of the competitive landscape and market trends. Identify initiatives for KPMAS to demonstrate innovation, which could take the form of creative partnerships, marketing, member retention, care delivery or delivery system improvements, or participation in innovative projects managed by the federal government, state government or community partners.
+ Operational Responsibilities: Manage the relationship and activities with functional areas as business, regulatory, operations, legal, and IT; oversee coordination validation and submission of reports and encounter data; coordinate resource leverage/alignment with other initiatives throughout the organization; set key performance metrics and ensure that the Medicaid line of business is well-served; drive and manage continuous improvement initiatives related to Medicaid; monitor compliance, organize audits, and coordinate corrective actions plans.
+ Business Acumen: Accountable for Medicaid line of business P&L and department budget. Make key financial and operational decisions regarding Medicaid functions; Develop capacity to identify new business opportunities for KPMAS to expand its Medicaid footprint; recognize industry trends and the needs of partners to develop short- and long-term Medicaid strategy; assess Medicaid network development and recognize either ways to improve relationships with existing partners or new opportunities for provider partnerships
+ Stakeholder Outreach: Represent KP with state regulators, departments, and representatives as well as local health departments, community-based organizations, etc.; proactively anticipate and respond to state and federal initiatives which impact Medicaid; manage contractual arrangements with the states, transportation provider, SBHCs, DOHs, FQHCs, CSBs, etc.
+ Organizational Collaboration: Build relationships with KP Program Office and ensure that the Program Office is appropriately notified of KPMAS Medicaid activities; manage relationships and collaborations with MAPMG, including administration of the Provider Advisory Group.
+ Management: Manages a team of Medicaid professionals and is accountable for managing and developing performance to meet department and regional strategies.
+ Minimum seven (7) years of management experience in Medicaid, health care or insurance industry.
+ Minimum five (5) years in product line management/health care delivery to special populations.
+ Bachelor's degree OR four (4) years of experience in a directly related field.
+ High School Diploma or General Education Development (GED) required.
License, Certification, Registration
+ Strong background working with Medicaid and/or Special Populations and unique health care needs.
+ Understanding of state and federal Medicaid framework and regulatory requirements.
+ Excellent negotiation skills, verbal/written communication skills.
+ Strong analytical and strategic planning skills.
+ Excellent public presentation skills.
+ Strong persuasive and interpersonal skills.
+ Knowledgeable of Medicaid health care delivery systems.
+ Knowledgeable of current trends in care management and industry standards related to care delivery to Medicaid population.
+ Demonstrated ability to build effective partnerships and influence others who may have different perspectives.
+ Must be a decisive, results-oriented manager or people. Must excel in developing a highly focused, cohesive team of professionals who are comfortable working in a team environment.
+ Demonstrated ability to work in a highly matrixed environment. Strong collaborative and team skills.
+ Experience with budgeting' state and federal compliance; state and federal policies and laws.
+ MBA, MSN, or master's in public health, health care administration strongly preferred.
+ Extensive knowledge of Medicaid health care delivery systems preferred.
+ Extensive knowledge of current trends in care management and industry standards related to care delivery to Medicaid population preferred.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
TITLE: Leader, Medicaid Strategic Business Unit
LOCATION: Rockville, Maryland
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.