Anticipated End Date:

2025-03-14

Position Title:

RVP II & Medicaid Plan President - Arizona

Job Description:

Position Summary

Be on the forefront of joining a dynamic company in a vibrant Medicaid market.  The President of our Arizona Medicaid Health Plan will have primary responsibility for the whole health, fiscal, operational, legislative, regulatory, and human resources objectives/agenda for assigned Medicaid health plan, part of the Medicaid Business Unit of Elevance Health, Inc.’s Government Business Division (GBD).  This role is responsible for aligning strategy and culture to achieve business goals and build a culture of accountability with people who are results driven with integrity, innovative, caring, and committed to excellence. This role provides the opportunity to work with one of the most comprehensive state Medicaid programs and populations in Arizona.

Executive Overview

Reporting relationship               West Region Medicaid President, working very closely with the Medicaid Chief Growth Officer.

Team scope                                 Approx 5, and then ramp up closer to bid preparation. Final team composition based on award requirements.

Critical stakeholders                 State Medicaid Officials, Advocacy Groups, Provider Groups, Federal Government, VP Provider Services, VP Quality, VP Operations, VP Whole Health, and VP Health Services

Leadership                                  Demonstrated ability to perform successfully as a leader of other leaders, teams, and cross-functional groups. The successful executive will build the framework and environment to support our new business in achieving human capital goals and support long-term growth to enable business success. Building strong, deep, and highly functioning teams is a requirement.

Mission and culture                 Demonstrated success in building and leading successful teams with a culture that is committed to execution, collaboration, communication and growth and learning environment for our associates. The application of regular coaching, timely performance management and active mentoring.

Location                                     Phoenix, Arizona

Leadership

Must have experience and demonstrate the ability to perform successfully as a leader of other leaders, teams and cross-functional groups.  A successful candidate will build the depth and operating environment that can achieve annual operating goals and support long-term growth for our business and our associates.  Building strong, deep and highly functioning teams is a requirement.  Experience performing these actions in a start-up environment preferred.

Business objectives

Leader must be adept at initial business development and procurement efforts, managing P&L to include revenue, cost management, SG&A and forward-looking product growth opportunities.  Plan leader should have actively led or participated in Cost Management, budget building and forecasting and successful premium rate management and renewals. Annual goals focus around:

Operating Gain

Growth

Leading Whole Health model and improvements

Cost of Care commitments

Revenue

Meeting or exceeding Quality and accreditation goals Ground Game Winning RFPs

Health Plan Operations

The preferred candidate would lead and participate in strategic market entry initiatives and external presentations and meetings supporting the forthcoming Medicaid Arizona Complete Care Request for Proposal. Oversight and participation in the development of growth strategies and retention initiatives for health plan. Oversee marketing and product growth strategies, business initiatives, school-based, faith-based, community-based, and special needs initiatives. Experience in Complex Population administration, working with stakeholders and new program implementation and growth which may include one or more of the following:

LTSS – Long-term Services and Supports, Long Term Care

BH – Program integration across populations and execution as part of overall plan operation.

FC –  Children in Foster Care or Child Welfare, Subsidized Adoptions or Guardianship

I/DD – Individuals with Intellectual and developmental disabilities

E/PD – Individuals with Physical Disabilities

Oversight and/or direct participation in relationships with key hospital, large physician practices/clinic and key ancillary providers such as dental and vision contractual relationships.  Drive provider collaboration and engagement in the areas of service and Payment Innovation. Expect the candidate would have the requisite network experience.

Strategic Planning

Leader must be adept at the development of the health plan’s business plan, quarterly reviews, and Business Operating Reviews and course corrections. Oversee resulting health plan budgeting and financials, including management of expenses, financial reports delivered to the State, capital budget planning and management. Incumbent must also possess strong strategic thinking and problem-solving skills.

Customer and Regulatory Objectives

The successful candidate will have a proven track record of developing and managing key State regulatory and legislative relationships and processes, including premium rates, covered populations, eligibility, benefit design, networks, administrative requirements, advocating for and implementing new products, influencing growth opportunities and policies, and being a thought leader for your state customer.

Responsible for establishing and leading an environment with the plan and senior leadership team that continually and effectively seeks to engage the state at multiple levels to meet and exceed service and performance goals while also driving innovation and trust. 

Work in matrix model with Government Relations officers to offer thought leadership in the political and legislative processes, and direction relative to contract negotiations with the state. Also aspire to create solutions for our state customers that achieve state and plan objectives that may also include new policy and product solutions.

Work in matrix model with growth partners to address and resolve claims, provider data, customer service needs and enhancements to meet and/or exceed customer service metrics. Also aspire to create solutions for our state customers that achieve state and plan objectives.

Matrix Culture

The preferred candidate will be a Medicaid subject matter expert with knowledge of Medicare and Exchange lines of business.

Work successfully across all lines of business. 

Work across matrix “shared service” growth partner business model – This includes Finance, Operations, Health Services, HR, IT, Actuarial, Legal, Compliance, other Shared Services as well as  affiliate assets.

Leverage Elevance Health Foundation – Strategic understanding of common interests among key constituents.

Successful internal and external communications – Liaison with corporate teams and external communications with the State, providers, members, community organizations and the media.

Compliance and Risk Management

Ensure contract and HIPAA compliance, including securing and coordinating resources necessary for such compliance. Certify monthly and quarterly financial statements, encounter reporting, quality audits, HEDIS/EPSDT and other required regulatory reports.  Oversight of risk management program, including fraud and abuse program compliance, and reporting responsibilities. Identify threats to financial assets, reputation, human resources and actively teach risk management to health plan leadership.

Culture and Mission

Demonstrated success in building and leading new successful teams with a culture that is committed to execution, collaboration, communication and growth and learning environment for our associates. The application of regular coaching, timely performance management and active mentoring. Assess and develop bench strength and retain talent in accordance with Plan-level retention and development goals.

The selected candidate will demonstrate the following capabilities:

Visionary Thinking

Establish strategies that create or sustain competitive advantage and drives a successful ground game. Think broadly and long-term, recognizing the impact of decisions and actions on the health plan and key stakeholders.

Drive a Consumer-Focused Culture

Lead whole health program, health equity, and service delivery to ensure that financial measures and quality outcomes are met.  Continually reinforce a focus on quality throughout all program verticals (e.g., recognition of product development, implementation and product delivery efforts and programs that support the variety of member populations served).

Drive an Innovative Culture

Act quickly to seize opportunities for innovation and growth.  Encourage others to champion need for effective problem solving, clearly communicating the rationale and urgency.

Foster Teamwork and Collaboration

Promote the importance of teamwork within, and across, large cross-functional groups.  Ensure the sharing of information and best practices. 

Influence and Negotiate

Communicate a clear and compelling case for implementation of solutions, ideas and proposals.  Build a broad base of support among key decision makers and influencers, using credibility to achieve organization impact.

Position Accountabilities

Build the depth and operating environment that can achieve annual operating goals and support long-term growth for our business and our associates. 

Keen attention to development of strong, deep and highly functioning teams is a requirement.

Achieve annual operating and business objectives through adept P&L management to include revenue, cost management, SG&A, Quality/Value Capture management, and forward-looking product growth opportunities.

Oversight and participation in medical management, including hospital census review, medical staffing, seasonality issues, case management strategies, BH/PH integration work, health equity focus, operating within the whole health model, detailed communications with the medical director and nurse leader and monthly accrual analysis.

Oversight and participation in the development of growth strategies and retention initiatives for health plan. Oversee marketing and product growth strategies, business initiatives, school-based, faith-based, community-based and special needs initiatives.

Oversight and/or direct participation in relationships with key hospital, large physician practices/clinic and key ancillary providers such as dental and vision contractual relationships. 

Drive provider collaboration and engagement in the areas of service and Payment Innovation.

Maintain oversight of a strong operating team with an ability to establish operating process, remediate service issues, implement new programs and support all areas of a health plan to accomplish established business goals, to include interfacing with national service centers and growth partner operations.

Navigate seismic growth in the Arizona Medicaid Managed Care environment and ongoing state fiscal pressures that pose significant challenges to our existing infrastructure to meet demand for revenue capture opportunities with a potential top line business. This includes dynamic provider environment with rapid consolidation of providers, threats to our unit cost position and access to services for our members, and competitive threats to our business model by emerging provider delivery models.

Evaluate changing market conditions and determine necessary changes to our value proposition to meet state needs/requirements, including understanding new financial, business relationship models and contractual agreements required, and evolving our business strategy and capabilities.  Develop existing talent to meet changing market conditions and recruit new talent as required.

Provide rationale to Regional President of required strategic direction to meet health plan goals, including potential investments required.  Convince enterprise program leadership to adopt product solution strategies that are beneficial to the plan.  

Win initial Arizona Complete Care Contract and any renewals of existing business, 100% of the time.  Create and pursue opportunities for white space and inorganic growth.

Position Requirements

Requires a BA/BS degree in a related field and a minimum of 12 years of related experience, including 8 years of experience in government sponsored health insurance programs and prior leadership experience; or any combination of education and experience, which would provide an equivalent background. Master’s degree preferred.

Preferred Skills, Capabilities and Experiences

Experience having led or participated in cost management, budget building and forecasting and successful premium rate management and renewals. Annual goals focus around:

Operating Gain

Growth

Leading Whole Health outcomes improvements

Cost of Care commitments

Revenue

Meeting or exceeding Quality and accreditation

Driving Ground Game strategy and execution to win in the market, every day, and drive growth.

Associate and Community impact

Experience in Complex Population administration, working with stakeholders and new program implementation.

A minimum of 15 years’ work-related experience within the government healthcare programs sector, preferably Medicaid, with a minimum of 8 years of experience in government-sponsored health insurance programs.

Proven success in influencing executives and managers. 

Display personal agility to work across a wide array of businesses and stakeholders to develop the credibility to achieve results.

Experience entering new markets or establishing new health plans. 

Knowledge of Medicare and Exchange lines of business.

Job Level:

Staff/Regional VP

Workshift:

Job Family:

BUS > Strategy, Planning & Execution

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.