President and CEO, MediGold

POSITION PURPOSE

The President & CEO, MediGold will provide leadership, direction, and management to MediGold's Medicare Advantage HMO and Health Insurance Company products in all states in which it operates. This individual will be responsible for strategy, medical delivery network, Medicare bid development, government programs, risk adjustment, operations, sales and marketing, medical management, quality, finance, actuarial and shared responsibility for legal, IT and compliance.

The President will report to the Trinity Health Executive accountable for MediGold, Trinity Health EVP, Chief Operating Officer. The President will work with the Trinity Health Executive accountable for MediGold in developing and recommending strategies for county expansions, bid development, annual AEP marketing strategy and overall strategic direction for MediGold.

ESSENTIAL FUNCTIONS

• The President & CEO will develop and execute the strategic direction of MediGold in conjunction with the Trinity Health EVP, Chief Operating Officer.
• Translating the MediGold strategic plan into operational actions and results through a combination of culture, people, operational processes and technology.
• Responsible for implementing policies, plan and operating practices as approved by Plan Board of Directors and as required by State regulations or statutes.
• Responsible for recruitment, development, support, and direction of  activities of the Plan's staff.
• Motivates and develops a fully engaged leadership team and colleagues capable of consistently meeting the objectives and goals of MediGold. Builds a team with core values aligned with Mount Carmel Health and Trinity Health.
• Responsible for development and administration of operational and capital budget.
• Responsible for development and oversight of annual and long-range plans of the Plan.
• Develops and maintains relationships with external agencies and organizations, locally and nationally (including community groups, provider agencies, and regulatory and governmental agencies).This would include effective advocacy with governmental and industry stakeholders.
• Develops processes and capabilities to monitor performance against risk-based arrangements and create appropriate provider-oriented incentives based on outcomes.
• Drives the advancement of clinical integration with the health system and ensure stronger partnerships exist between the Plan and the provider community. A special focus will be on developing clinical and financial integration with Trinity Health Clinically Integrated Networks (CINs) and medical groups.  This integration will lead to success in higher quality, more connected care at a lower total cost of care.
•  Responsible for expenditure of all funds and for assuring that such expenditures are within the budgetary guidelines approved by the Board of Directors and Trinity Health.
• Gives direction to Marketing, Finance, Health Services, and Operations and provides leadership in the organization of providers, physicians, and hospitals who function as part of the Plan.
• Responsible for the provision of effective communications, preparation of business status report(s) to the Plan Board of Directors, and regulatory agencies, identification of recommendations to Plan Board of Directors requiring Board action.
• Ensures a consistent focus on maintaining high quality care and services to members of the Plan as well as internal employee satisfaction.
• Oversight of the strategic contract for information systems and Business Process Outsourcing (BPO) such that MediGold provides excellent service in all provider and member facing functions with the highest level of payment integrity. Ensures there is a technology strategy that maximizes the impact of technology on key outcomes and performance indicators.  This strategy would include maximizing the appropriate impact of artificial intelligence.
• Develops and implements organizational infrastructure around plans and objectives regarding growth and expansion.
• Develops partnerships with and maintains open lines of communication with regional health ministry Executives, Trinity Health leaders, and an active participant in the MCHS leadership meetings.
• Takes actions to assure high-quality care and service as measured by STAR ratings.
• Active participant in the community raising the visibility of MediGold and MCHS by being active in community organizations and other activities.
• Develops partnership like relationships with other health systems and physician organizations that take effective risk contracts with MediGold.
• Annually, develops financial plans ensuring the profitable growth of MediGold.
• Directs and assures compliance with State and Federal regulations, while partnering with MCHS and Trinity Health Compliance leaders.
• Must be able to work all levels within and outside the organization, including auditors, regulators, customers, and colleagues, etc.
• Promotes a Culture of Safety by adhering to policy, procedures and plans that are in place to prevent workplace injury, violence, or adverse outcome to associates and patients.
• Proactively drive relationships outside of the immediate service area to ensure that the Plan is responsive to the needs of outlying partner providers.
• Visible and vocal champion of the Plan and its provider partners in the communities it serves.

MINIMUM QUALIFICATIONS

• Bachelor’s degree with Master’s preferred.
• At least ten (10) years of experience in a leadership role in a relevant health plan with progressively increasing responsibilities.
• Must have executive level leadership in management of health plan; experience overseeing the growth, operations and financial results of a health plan.
• Experience working in a health plan that is part of an integrated delivery system is preferred.
• Track record in increasing revenue and profits.
• Experience in matrix management.
• Significant Medicare Advantage experience.
• Effective communication skills.
• Strong business acumen.
• Unquestionable integrity.
• Experience with managing risk partners (at risk provider groups).

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

• Must be able to adapt to frequently changing work priorities.
• Must be able to travel as needed to the various Trinity Health sites.