This is a highly visible role responsible for obtaining and maintaining credibility with state regulators, legislators, advocacy groups, community organizations, providers and associations and ensuring we drive the overarching Medicaid platform to serve our members. We serve the health care needs of low-income adults and children including those with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. You'll be our 'account manager' for the state relationship; accountable for all aspects of profit-and-loss, driving performance, leading strategic planning while meeting revenue, membership and operating income objectives. The Health Plan CEO is accountable for the market financials, strategy, growth and day-to-day operational with oversight of approximately 150,000 Medicaid members.
In this role, the ability to handle ambiguity will be a must. We are committed to bringing new levels of innovation and performance to the ways that we deliver for our members and customers. You'll be part of an intense, focused leadership team that's driving operational excellence and results across a matrixed organization.
Primary Responsibilities:- Create an overall vision for the health plan team to ensure they can navigate a rapidly changing industry and leverage innovation to capture opportunities for growth and/or improvement
- Develop and execute market-specific strategies to drive sustainable and profitable growth while setting the strategic direction to drive business growth
- Drive industry-leading customer service and satisfaction levels as measured in Net Promoter Scores
- Build, develop, improve, influence and expand relationships with key government sector customer groups, providers/provider networks within the market
- Manage multiple levers of health plan profitability (e.g. rate advocacy, member retention, utilization management, Star performance and Medicaid Quality)
- Employ strategies to lead market share across the statewide Medicaid footprint
- Ensure the health plan grows relative to competitors, meets financial targets, manages budgets effectively, and maintains profitability while balancing cost efficiency and high-quality service delivery
- Ensure adherence to regulatory requirements and industry standards, streamline operational processes, and enhance efficiency to achieve consistent and reliable performance for our members
- Oversee clinical operations and quality initiatives, ensuring compliance with healthcare standards, improving member health outcomes, and maintaining high levels of care and service quality
- Cultivate and sustain strong relationships with members, community groups, state regulators, and healthcare providers to influence program design, develop support for program efforts, secure approvals, and foster collaborative partnerships
- Promote a positive organizational culture, enhance employee satisfaction, and implement strategies to attract, retain, and develop a motivated and high-performing workforce
- Achieve enterprise goals and ensure alignment of MBOs for health plan and matrix partners by engaging and collaborating with functional leaders
- Ensure diverse perspectives guide strategic decisions by creating a supportive atmosphere where every team member feels safe sharing tough issues or concerns
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 10+ years of successful leadership experience in leading and managing people
- 10+ years of P&L and/or extensive budgeting experience as well as strategic planning and development
- 7+ years of experience with community-based organizations, FQHC's, provider/hospital systems, behavioral health, Medicare Advantage/Medicaid Dual Special Needs Network (DSNP) systems
- Expert level of proficiency working in a fast-paced matrix organization/environment with an enterprise focus
- Prior leadership experience in program execution
- Experience building and maintaining service-oriented culture across remote field-based organization
- Demonstrated ability to build and maintain effective relationships with external partners
Preferred Qualifications:- Prior executive level experience in LTSS (Long-term Services and Supports)
- Prior executive level experience in HCBS (Home & Community Based Services)
- Prior executive level experience with NF (Nursing Facilities)
- Prior executive level experience in dealing with multiple State Agencies
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $225,000-$375,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
