Reporting to the National Senior Vice President of Medicaid, the Executive Director of Care Model Strategy and Performance Management will direct efforts at a national level to develop Medicaid care model solutions and spread solutions across KP-s portfolio of Medicaid programs in all markets. This leader will partner closely with Medicaid leaders, the Permanente medical groups, national care continuum leaders and health plan leaders. The ED will be responsible for improving utilization and meeting targets through the execution of the Medicaid care model across all markets. An ability to lead people across a matrix through influence (and not through organization design) is an essential capability for this leader. S/he will need to ably partner with all care coordination and care delivery leaders in the markets to align agendas and initiatives in support of their Medicaid strategies and targets and also to form trusting partnerships with Permanente physician leadership to design and deploy care delivery models that bring high quality, efficient care to serve Medicaid patients.
Essential Responsibilities:Collaborates with Medicaid leaders and national partners to develop national Medicaid care models and platforms (i.e., risk stratification, care coordination, network strategy, new member onboarding, patient engagement, social and community supports)Leads national initiatives focusing improving quality, affordability and patient satisfaction for Medicaid and patient vulnerable populationsDrives clinical integration across hospitals, physicians, health plan and other critical partners Oversees fidelity to the national care models, disseminates best practices, and leads innovation to continually renew the care models Serves as an internal expert for federal and state health policy strategy and advocacy in matters relating to care coordination and care delivery models for Medicaid and vulnerable patients Actively maintains expert level subject matter expertise in care delivery strategies that deliver excellent outcomes and high quality on tight Medicaid budgets Provides input to KP-s national and state level Medicaid strategies with respect to the types of populations and related care models that KP should strategically focus on for growth Partners with market leaders to deploy Medicaid care models, oversee fidelity to national Medicaid and vulnerable patient care models, disseminate best practices, and lead innovation to continually renew the models Directs analytical activities to monitor performance against clinical, quality and operational goals and to deeply understand the nuances of each Medicaid program, segment and market, and measure performance of interventionsCollaborates with Community Benefit leaders to align resources in support of national Medicaid programs and augment care models with social services in local markets Identifies market-specific priorities and determines the appropriate strategic approaches that will drive high quality care and excellent health outcomesLeads and influences stakeholders across KP to build awareness of Medicaid program needs and marshal resources to achieve strategic Medicaid goals Basic Qualifications:
Experience
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.
Education
BA in business or related area required, Registered Nursing Degree
License, Certification, Registration
N/A
Additional Requirements:
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
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
Preferred Qualifications:
Experience working with State Medicaid agencies on innovative models as well as negotiating contracts and rates is preferred
Experience in Medicare Advantage or in programs serving dual eligible preferred
Master’s Degree preferred