VP, Medicaid California and Hawaii

VP, Medicaid California and Hawaii

Reporting to the National Senior Vice President of Medicaid, with accountability to the Regional Presidents of the Northern California, Southern California and Hawaii regions, the VP Medicaid, California and Hawaii 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 California and Hawaii. 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 California, Hawaii and for all KP regions. The Vice President 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 Northern California, Southern California and Hawaii. However, the position is not directly responsible for leadership or management of the medical care services provided by KP.

This position has a target base salary of $315,000 to $393,750 and is eligible for incentive compensation, an executive allowance, comprehensive health, wellness, time off, savings, and retirement benefits, as well as relocation support, as applicable.

Essential Responsibilities:

• 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, California and Hawaii 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 the California and Hawaii regions. Coordinate and align regional Medicaid strategy development and plans with regional and national line of business, care delivery and functional strategies and policies.
• Directly manage designated Medicaid leaders in CA and HI. Lead, manage, mentor and develop Medicaid leaders and staff in California, Hawaii and across the KP program
• 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.
• Collaborate with KP national and regional Community Health leaders to align social health and safety net initiatives with CA and HI Medicaid strategies.
• 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.
• Support the development of legislation, regulation and KP strategies to facilitate care and service to beneficiaries who are eligible for both Medicare and Medicaid coverage (Duals Eligibles).
• Understand, plan, coordinate, and prioritize support from the regional health plan, national functional areas, and the national Medicaid team on initiatives and deliverables.
• Serve as an internal expert for federal and state health policy strategy and advocacy in matters relating to population health, social health, and care coordination for vulnerable populations.
• Sponsor, lead, manage or participate in initiatives that are critical to our participation in Medi-Cal and may also impact our other business lines.

Basic Qualifications: Experience

• Minimum five (5) years of prior healthcare leadership experience, including Medicaid and other State Sponsored programs.

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.
• Experience and understanding of care delivery, care management and social issues affecting health and care delivery for low-income and other vulnerable populations.
• Understanding of Kaiser Permanente 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.
• One would typically find this depth of understanding in a person who had 10 or more 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.

Preferred Qualifications:

• Expertise and experience in the California health care and Medicaid market is strongly preferred
• Experience in health care management and the Medicaid regulatory environment in California and Hawaii 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

Primary Location: California, Oakland, Ordway Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Flexible Employee Status: Regular Employee Group/Union Affiliation: NUE Executives|NUE|Non Union Employee Job Level: Executive/VP Department: Po/Ho Corp - Medicaid - 0308