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Medicaid Executive Director

4 weeks ago

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

As the Executive Director of Medicaid, you will play a key role in leading Kaiser Permanente's Medicaid strategy, planning, and operations in Maryland. Reporting to the National Senior Vice President of Medicaid, you will be accountable to the Regional Presidents of the Mid-Atlantic States (MAS) region. Your primary responsibility will be to lead, manage, and coordinate KP's Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships, and related activities in Maryland.

Key Responsibilities
  • Lead and manage KP's Medicaid strategy, planning, and operations in Maryland.
  • Work closely with national, shared service, and MAS market leaders to support the implementation of the Medicaid strategy, regulatory, and operational requirements.
  • Lead, manage, mentor, and develop Medicaid leaders and staff in Maryland and across the KP 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 KP 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.
  • 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 KP functions are aware of and compliant with state and Federal Medicaid requirements.
  • 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.
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 KP and integrated health plan and care delivery models and issues.
  • Competencies in strategic, financial, and operational planning and program management.
  • Ability to lead in a highly matrixed organization, including the ability to establish, lead, and collaborate effectively through influence and relationship, rather than through reporting relationships.