Executive Director, Medicaid Program Leader

2 weeks ago

Rockville, Maryland, United States Kaiser Permanente Full time
Job Summary:

As a key leader of Kaiser Permanente's Medicaid national line of business, the Executive Director of Medicaid, Maryland is responsible for leading, managing, and coordinating the company's Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships, and related activities in Maryland. This role involves close coordination with various Kaiser Permanente regional, national, and shared service leaders and functions that support Medicaid operations and the services provided to beneficiaries in Maryland and for all Kaiser Permanente regions.

Key Responsibilities:
  • Lead, manage, and coordinate strategy, planning, health plan operations, compliance, regulatory, and industry relationships, and related activities in Maryland.
  • Work closely with all national, shared service, and Mid-Atlantic States market leaders and other care delivery and medical group leaders to support the Mid-Atlantic States with implementation of the strategy, regulatory, and operational requirements.
  • Lead, manage, mentor, and develop Medicaid leaders and staff in Maryland and across the Kaiser Permanente program to provide subject matter expertise to support the market 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 Kaiser Permanente's Medicaid strategy, operations, and performance.
  • Monitor and maintain a deep understanding of the national, Maryland 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 Maryland. Coordinate and align regional Medicaid strategy development and plans with regional 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 assure adequate payment levels and efficient regulation for Medicaid plans and providers.
  • Collaborate with National Medicaid Compliance to ensure all Kaiser Permanente 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 Kaiser Permanente relationships with the States' Medicaid agencies.
Requirements:
  • Minimum ten (10) years of professional experience in the health insurance business or in a consulting role focused on projects supporting Medicaid, Medicare, and other government-sponsored programs or care delivery systems supporting low-income and vulnerable populations.
  • BA in business or related area required.
  • Extensive knowledge and expertise in Medicaid and CHIP.
  • Demonstrated experience and success in health plan and/or care delivery operations and business development in Medicaid Managed Care.
  • Prior healthcare leadership experience for five or more years, including Medicaid and other State Sponsored programs.
  • Understanding of Kaiser Permanente and its business operations.

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