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Medicaid Business Director

2 months ago

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

Kaiser Permanente is seeking a seasoned leader to serve as the Executive Director of Medicaid in Maryland. This key role will be responsible for leading, managing, and coordinating KP's Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships, and related activities in Maryland.

Key Responsibilities:
  • Develop and implement Medicaid strategy, planning, and regulatory relationships to ensure compliance and optimal performance.
  • Collaborate with national, shared service, and regional leaders to support Medicaid operations and services in Maryland and across KP regions.
  • Lead and manage Medicaid leaders and staff in Maryland and across the KP program to provide subject matter expertise and support 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.
  • Develop, implement, and modify Medicaid participation strategies in Maryland, aligning 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, developing and executing legislative, regulatory, and advocacy strategies to ensure adequate payment levels and efficient regulation for Medicaid plans and providers.
  • Ensure all KP functions are aware of and compliant with state and Federal Medicaid requirements, identifying and supporting 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 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 its operations.