Reporting to the National Senior Vice President of Medicaid, with accountability to the Regional Presidents of the Mid-Atlantic States (MAS) region, the Executive Director of Medicaid, Maryland is a key leader of the Medicaid national line of business and responsible for leading, managing and/or coordinating KP’s Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships and related activities in Maryland. The position involves close coordination with a variety of KP regional, national, and shared service leaders and functions that support Medicaid operations and the services provided to beneficiaries in Maryland and for all KP regions. The Executive Director maintains relationships and represents KP with a variety of external partners and stakeholders including: regulators; safety net and other providers; other health plans; industry associations; advocacy groups; media and others. This role involves extensive coordination and collaboration with the KP medical care delivery system, including Permanente Medical Groups, serving Maryland and Virginia.
Essential 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 MAS market leaders and other care delivery and medical group leaders to support MAS with implementation of the strategy, regulatory and operational requirements.
Lead, manage, mentor, and develop Medicaid leaders and staff in Maryland and across the KP program to provide the 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. 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 KP 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 KP relationships with the States’ Medicaid agencies.
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
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
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
Preferred Qualifications:
Experience in health care management and the Medicaid regulatory environment in Maryland is preferred
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