Vice President, WV Medicaid Market

Job ID: J123830
Company: Highmark Inc
Location: Parkersburg, WV, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 13, 2018

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Description

I.    GENERAL OVERVIEW:  


This position is responsible for the overall performance of the entire health plan, for quality of care and service as well as financial performance. This position is responsible for delivering the revenue and operating gains for this market. They are accountable for establishing and maintaining strategic relationships with State of Virginia, our Board of Directors and external owners, the health care provider partners, key vendors, and the community at-large. This position sets the strategic direction and insurers it’s execution for revenue management, federal and state regulatory and contract compliance, care management, and service to all key constituents through direct and indirect reporting relationships with the CMO, COO, CFO and Chief Compliance Officer as well as other key business partners.  This position must provide strategic direction and management oversight of staff performing the core functions for West Virginia Family Health, many of which are provided by Gateway Health through an administrative services agreement.


II.    ESSENTIAL RESPONSIBILITIES:

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

  • Develops strategic goals and business plans to be executed at the health plan.  Collaborate on the development and oversee implementation and reporting of the annual short- and long-term strategic business plan, budget, and financial projections to include all reporting required by local, state, and federal officials / agencies.

  • Working with Actuary, Finance, executive leadership and key business partners, lead the state contract RFP or rate renewal activities to ensure the acquisition, retention, and profitability of the West Virginia Family Health business.  Tasks include facilitating the proposal or rate renewal process, preparing rate proposals and related materials for executive leadership review/approval and for submission to the state, and serving as business lead in negotiations with the state.

  • Develop and maintain mutually beneficial relationships with key elected officials, key community organizations and other influential local entities in support of the state's Medicaid programs and members as well as WVFH market and community goals.  Stay current with federal and state health care reform, legislation and regulatory activities and proposed changes, assessing impacts, advising WVFH's public and private positions and engaging as needed to shape regulatory and contract outcomes.

  • Develop and maintain positive, mutually beneficial relationships with strategic provider partners within the market.  Partner with and provide both strategic and tactical direction to the provider network contracting team to build and enhance the West Virginia Family Health provider network and related vendors to achieve the care, service and financial goals of WVFH.  As needed, engage in provider relations escalated service issues to achieve high provider satisfaction and deliver quality care to members.

  • Working with Compliance, provide strategic direction and tactic guidance to the West Virginia Family Health compliance programs and practices to ensure full compliance to federal/state regulations and contract terms and conditions.  In coordination with Compliance, provide business leadership to all compliance reviews, such as ERQ and ISCA, as well as other external organizations such as NCQA.

  • Lead and manage the West Virginia Family Health executive team and organization to execute our care and service commitments to our key constituents with a primary focus on serving and caring for our members.  Work to continuously improvement the health plans performance, minimize performance risks, and engage in escalated issues to achieve mutually satisfactory outcomes, with a focus on membership care and satisfaction.

  • Other duties as assigned or requested.


III. QUALIFICATIONS:

Minimum
•    Bachelor’s Degree in Business Administration or related field
•    Eight years or more management experience in a matrixed organization, to include direct experience in strategic planning, financial management, community affairs, sales, and operations    

Preferred

•    Master’s or Doctorate Degree
•    Government programs, commercial health plan, or managed care management experience
•    Local market health care experience


Knowledge, Skills and Abilities
•    Leadership and collaboration skills
•    Strategic Planning and Financial Management
•    Community / Government Relations
•    Excellent written and oral communication and presentation skills
•    Ability to partner with others and maintain positive working relationships
•    Sales and financial aptitude, knowledge of customer needs and market trends


IV. SCOPE OF RESPONSIBILITY


Does this role supervise/manage other employees?   

Yes


Is Travel Required?
Yes


 

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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