Director, Medicaid Program Management

3 days ago

Portland, Oregon, United States Kaiser Permanente Full time
Job Summary

Reporting to the Senior Vice President of National Medicaid, the market Medicaid line of business leader is responsible for the overall performance of the NW markets Medicaid line of business programs, with a focus on financial performance and membership growth.

Oversees all aspects of market Medicaid programs, state contracting arrangements, product development, compliance with State and Federal Policies and requirements.

Strategically builds, manages and sustains external business relationships, particularly with state and local regulators. Accountable for product development, administrative processes, interdepartmental communication, and regulatory requirements.

Develops an annual strategic plan and updates market and National Executive Sponsorship on strategic issues/development, business performance, and progress against objectives.

Demonstrated passion and creativity in developing models of care serving low income vulnerable populations.

Key Responsibilities
  • Directs the delivery of large-scale programs or components with multiple workstreams and strategic business goals across departments, functions, or regions with responsibility and accountability for achieving program outcomes from initiation to close-out in an extended or open-ended time frame.
  • Reviews program plans and determines program demands for the most complex program initiatives in order to identify and manage scope, and supply appropriate staffing to complete program plans within scope, budget, and schedule.
  • Oversees the program financials of large, high-profile, dynamic program initiatives and ensures they are managed within budget allocations.
  • Reviews performance across a portfolio of programs to ensure programs effectively deliver maximum long-term value or benefit to the organization, and makes adjustments as needed in an uncertain environment where scope may be fluid.
  • Develops and disseminates processes and procedures for the development and execution of organizational change management (e.g., user adoption, implementation, and training plans).
  • Establishes and oversees proper program management practices in regard to allocation of resources, schedules, and task assignments.
  • Directs programs team and holds team accountable for results.
  • Proactively monitors, identifies, and mitigates program risks, issues, and trigger events across multiple interdependent programs by leveraging expertise and recommending changes to program processes based on the analyses and identification of trigger events.
  • Directs adherence of program activities to policies and procedures by ensuring program plans and team members follow KP, departmental, and/or business line policies and procedures.
  • Directs the alignment, buy-in, engagement, and support of diverse programs stakeholders to set long-term program goals by building and maintaining relationships as well as communicating appropriately with internal customers, third-party vendors, executive management, and business leaders; and clarifying accountability and authority across stakeholders.
  • Builds close relationships with key stakeholders across multiple functions based on their level of influence and decision-making and guides teams in identifying the right stakeholders for their programs.
  • Directs programs goals, influences the prioritization of deliverables, coordinates all business processes (e.g., project change management, communication), and facilitates decisions necessary for programs delivery by partnering with programs sponsors and/or review boards.
  • Communicates tough issues to stakeholders while maintaining an independent opinion, providing recommendations, delivering formal presentations, and providing reports to executive audiences.
  • Engages with senior and executive stakeholders to identify long-term value to the organization and define success.
  • Oversees vendor performance and provides direction for service improvements or revisions to strategy.
  • Partners with Procurement and/or Legal to develop service level and/or scope of work agreements as appropriate.
  • Directs partnerships and contract negotiations with vendors.

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