VP, Government Health Programs, Banner Plans & Networks

Primary City/State:

Phoenix, Arizona

Department Name:

Plan Admin

Work Shift:

Day

Job Category:

General Operations

POSITION SUMMARY
This position has overall accountability for producing desired results associated with service excellence, quality clinical outcomes, market share maintenance/expansion, and financial integrity of operations at Health Plan, being highly visible at the facility, region and system levels, and includes the development and management of health plan growth and improvement plans, efficient utilization of resources, and program development. This position is responsible for developing and fostering positive relationships with all constituents including regulators, providers, employees, volunteers, external agencies/associations, and the community. This leadership position is also responsible for the development of short and long-term plans for carrying out the goals and objectives of the Medicare health plan as developed by leadership and the Board of Directors. This position is responsible for serving as a change agent and driving, supporting and modeling a service-oriented culture focused on member safety and overall member experience. This position serves as the principal link between health plan activities and the community, local Board, and participating providers.

CORE FUNCTIONS
1. Partners with the health plan leadership and Board of Directors to execute the health plan’s mission, vision and values as well as the operational excellence and short- and long-term goals of the health plan. Promotes high performance expectations for the health plan leadership/management team. Directs and ensures the effective identification, recruitment, development, and maintenance of talent for current and future organizational needs to achieve goals and objectives. Sets clear expectations and holds team members accountable for producing desired outcomes. Motivates and develops team members and promotes teamwork.

2. Directs and oversees financial stewardship with an emphasis on providing efficient utilization of resources (maximizing operating margin) and making appropriate decisions pertinent to capital and technology acquisition (maximizing return on investment). Partners with leadership and the Board of Directors to evaluate the effectiveness of the organization and monitor its results.

3. Manages the health plan by providing general oversight of all health plan activities and operational efficiencies. Demonstrates strong acumen in planning and organizing business objectives to achieve quality outcomes in key health plan performance metrics.  Acts as regulatory liaison by representing the health plan externally to government/external agencies and establishes the agenda regarding health plan engagement, legislation and market dynamics. Ensures timely and accurate reporting to regulatory agencies at the local, state and federal level.

4. Maintains a excellent service and healing culture with high expectations established for positive member experiences. This culture should create an environment that results in high employee retention and high employee satisfaction. This service excellence culture includes ongoing and meaningful communication with employees to ensure that all staff members are well informed and recognized appropriately. Serves as a leader in developing the Continuous Quality Improvement process, in educating staff and role modeling Service Excellence, and in assisting with cultural transformation.

5. Develops and maintains positive relations with participating providers, the community, members, regulatory agencies, contractors, and other applicable parties, ensuring and fostering a high level of collaboration within a highly matrixed team environment to coordinate activities, review work, exchange information, and resolve problems. Promotes collaboration and serves as a liaison to providers and members. Works with the Banner delivery system to ensure the provision of facilities and services that foster a high level of professional practice and responsiveness to the needs of the community, including high-quality patient health care and desired medical management outcomes.

6. Provides leadership and actively participates in the development and implementation of strategic, tactical, program and operational planning. Utilizes forecasting and planning processes to identify capital and technology acquisitions and program development opportunities which achieve desired health plan growth related to capacity and capability of services offered, ensuring the delivery of services that are responsive to the needs of the community.

7. Participates in community and industry activities to enhance community recognition of the organization and the health plan, ensure proper regulatory and accreditation standards, and to obtain cooperation and support of the community on issues that impact the health plan. Positively represents the organization and the health plan in the community and/or with various national, regional, and/or local entities, garnering desired support to enhance program development.

8. Maintains on-going communication with health plan employees to ensure the staff is well informed regarding the strategic direction of the Insurance Division. Conducts routine employee forums to inform and keep abreast of the issues that employees are facing and ensures that issues are addressed timely and appropriately to avoid third party intervention.

9. This highly complex and dynamic role has full executive leadership for an assigned health plan(s). Attains and monitors a complex mix of services and innovations necessary to sustain a competitive advantage and achieve pre-eminence for the health plan in its community in a fast-moving healthcare environment. Excellent regulator, provider, employee, and community relations are vital and ever challenging. Scope of responsibility includes leading health plan strategy and operational planning, consistent with organizational priorities, to identify and achieve short and long-term goals and overseeing day-to-day operations of health plan. This position also has overall budgetary responsibility for assigned areas of responsibility. Serves as a member of senior leadership for the Insurance Division

MINIMUM QUALIFICATIONS

Requires a strong knowledge in operations as normally obtained through the completion of a Bachelor’s degree in Healthcare Administration, Management, Business, or related field, coupled with a minimum of ten years of increasingly responsible administrative leadership experience in health plans.

Experience representing a health plan to its community, with evidence of strengthening the health plan’s presence and impact. Proven track record of partnering with Banner colleagues to achieve desired health plan-specific and organizational outcomes. Proven experience in leading fiscally sound, profitable, efficient, and responsible healthcare operations. Strong financial and business acumen, including a keen understanding of operational and financial measures that define success, as well as budgeting and forecasting methodologies, including working knowledge of capital planning and capital investment practices. Knowledge of modern national trends in managed care quality and member safety.

Must demonstrate expert-level knowledge and awareness of area of expertise in designated health plan, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable. Proven track record of driving successful performance outcomes and accomplishing organizational goals including successful bid procurement and achieving industry best quality and performance metrics.

Must demonstrate skills and business acumen through direct leadership experiences such as: Anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve department goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; demonstrating a passion about continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.

Leadership style and characteristics necessary to effectively perform in this role include: strong work ethic; results-oriented; persuasive; motivational; able to make rational decisions in difficult situations; inspirational; honorable; confident; systems-thinker; innovative; life-long learner; courageous; high-energy; integrity; collaborator; ability to work with teams; good listening; nonvolatile; values multiple disciplines; community visibility and leadership; and passionate about continuously improving and providing high quality care and service excellence to patients, families, employees and physicians.

PREFERRED QUALIFICATIONS

Master’s degree preferred.

Medicaid and Medicare leadership experience preferred.

Experience working with Centers for Medicare and Medicaid Services Successful Medicare and Medicaid bid procurement preferred.

Additional related education and/or experience preferred.