The VP of Medicaid is a key leader of the Medicaid national line of business and responsible for leading, managing and/or coordinating KP's Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships and related activities in multiple states. The position involves close coordination with a variety of KP regional, national, and shared service leaders and functions that support Medicaid operations and the services provided to beneficiaries. The existing Regional Medicaid Leaders will report into this position. The Vice President of Medicaid maintains relationships and represents KP with a variety of external partners and stakeholders including regulators; safety net and other providers; other health plans; industry associations; advocacy groups; media and others. This role involves extensive coordination and collaboration with the KP medical care delivery system, including Permanente Medical Groups. However, the position is not directly responsible for leadership or management of the medical care services provided by KP.
Essential Responsibilities:
Lead, manage and coordinate strategy, planning, health plan operations, compliance, regulatory and industry relationships, and related activities in multiple states
Work closely with all national shared service and market leaders and other care delivery and medical group leaders to support Medicaid with implementation of the strategy, regulatory and operational requirements
Identify, lead and monitor initiatives to improve financial performance and cost of care, including collaborating closely with care delivery
Partner with the National Health Plan to build out critical core capabilities
Directly manage designated Medicaid Leaders responsible for contract management and engagement in multiple states; lead, manage, mentor, and develop Medicaid leaders and staff across the KP program to provide the subject matter expertise to support the markets and shared services with implementation of Medicaid regulatory requirements
Maintain a deep understanding of current and potential state and Federal Medicaid, CHIP and related legislation and regulations, and their impact on KP Medicaid strategy, operations, and performance
Monitor and maintain a deep understanding of the national and state health plan and provider competitive environment as it relates to Medicaid, dual eligibles and vulnerable populations
Lead and coordinate the development, implementation, and ongoing modification of Medicaid participation strategies in multiple states; coordinate and align regional Medicaid strategy development and plans with market-level and national line of business, care delivery and functional strategies and policies
Collaborate with regional and national government relations to monitor and influence legislation and regulation related to Medicaid; develop and execute legislative, regulatory and advocacy strategies to ensure adequate payment levels and efficient regulation for Medicaid plans and providers
Collaborate with National Medicaid Compliance to ensure all KP functions are aware of and compliant with state and Federal Medicaid requirements; identify and support implementation of changes needed to achieve and maintain compliance
Establish, modify, and monitor a comprehensive set of key performance metrics across all functions to monitor performance and compliance of the Medicaid line of business
Collaborate with regional and national finance, including Medicare and Medicaid finance, to monitor and help manage financial performance
Implement ongoing changes to Medicaid organizational structure, staffing and processes to improve effectiveness and efficiencies
Monitor, collaborate and support initiatives to improve financial performance of the Medicaid line of business
Responsible for the management of KP relationships with the States' Medicaid agencies
Support the development of legislation, regulation and KP strategies to facilitate care and service to beneficiaries who are eligible for both Medicare and Medicaid coverage (Duals Eligibles)
Understand, plan, coordinate, and prioritize support from the regional health plan, national functional areas, and the national Medicaid team on initiatives and deliverables
Sponsor, lead, manage or participate in initiatives that are critical to our participation in Medicaid and may also impact our other business lines.
Basic Qualifications:
Experience
Minimum fifteen (15) years of work experience, preferably in the health insurance business or in a consulting role focused on projects su