VP- Medicaid Programs

📁
Business (Non-Clinical)
📅
1911272 Requisition #

GENERAL SUMMARY:

The Vice President of Medicaid Programs is responsible for the strategic direction and business operations for the managed Medicaid divisions of Health Alliance Plan, part of the Henry Ford Health System. This position provides the vision and leadership to enable profitability, growth and stability of the Medicaid lines of business including Special Needs Plans (D-SNP) and manages key regulatory relationships in order to address issues including premium rates, eligibility, membership assignment, program changes, and contractual requirements.


With a team of product specific direct reports and many matrix relationships, the Vice President will collaborate with matrix leaders in marketing, government relationships, operations, medical management, network contracting and performance management, risk adjustment and compliance, the Vice President will drive membership growth, community outreach and manage the medical loss ratio and achieve the highest levels of quality and member satisfaction. This position’s direct reports include two - four leaders (Managers and/or Directors) and provides oversight of 20+ indirect reports.

The successful candidate will bring past experience and understanding of working in the health insurance industry, specifically in government programs that are role models of success. S/he will also have demonstrated applying sound and replicable business solutions to address the changing focus of healthcare to a more consumer-oriented, risk-based model that incorporates social determinants of health. This position calls for the talents and experience of a respected and dynamic leader who will establish credibility with members, providers, executives and employees.  S/he will have an excellent reputation with state MMP leadership gained through proven success within the healthcare industry.


This is a wonderful opportunity to grow HAP’s Medicaid business from its current state to one that is significantly larger.  HAP is part of the Henry Ford Health System, one of the largest delivery systems in Michigan.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Business Development and Strategy

  1. Develop and oversee implementation of annual and multi-year business plans.
  2. Collaborate with HAP Senior Vice President and Chief Business Development and Marketing Officer to define develop innovative and differentiated program offerings to support growth, earnings and further the Henry Ford Health System mission.
  3. Collaborate with HFHS Senior Vice President and Chief Strategy Officer to establish customer experience strategy across all Medicaid and Commercial Individual programs and with accountable leader within Henry Ford Provider System to drive medical cost control and growth targets.
  4. Establish the business objectives for critical functions that impact business performance (including functions such as contracting, population health, provider performance management, operations, risk adjustment and medical cost management). Work with matrixed business leaders in these functions as they develop strategies to execute on these defined business objectives.
  5. Establish business objectives for membership growth, including acquisition and retention objectives. Integrate strategies that increase membership through alternative sources, outreach, education activities and strategic provider and 2 of 4 community relationships. Develop and execute value propositions, market positioning and voice to consumers, community leaders and affinity partners.
  6. Assess changes in the external environment including state and federal government, identify implications and develop plans to address.
  7. Remain alert to trends and federal and state policies and new opportunities to support government sponsored products such as ACA Exchange business.
  8. Collaborate with VP of Strategy and Business Delivery to support strategy development and monitoring, and delivery of technical solutions to support Medicaid programs.
  9. Provide input to function leaders on issues impacting business success including medical cost innovation, quality, operations, member experience and government affairs.
  10. Identify local alliances and relationships, including key decision-makers and influencers in the community. Develop, maintain and leverage relationships with key external stakeholders in target markets.
Distribution and Measures Management

  1. Lead and oversee measures management for Medicaid products in all markets.
  2. Ensure Medicaid strategic plans are translated into tactical goals, objectives and lead measures that guarantee performance measures are met or exceeded.
  3. Partner with executive shared services teams to ensure that enterprise-wide quality, operational, financial and leadership expectations are met.
  4. Partner with Medicare Product Manager to ensure Medicaid priorities are clear and execution occurs in line with expectations in those matrixed markets.
  5. Collaborate with cross functional leaders to identify and implement opportunities for improved business performance.
Operational Management

  1. Lead, direct and oversee operational management for Medicaid products in all markets.
  2. Ensure Medicaid strategic plans and customer experience strategy are translated into tactical goals, objectives and lead measures that guarantee operational objectives are met or exceeded.
  3. Collaborate with cross functional leaders to identify and implement opportunities for improving operational performance.
  4. Develop and lead a Medicaid vendor and/or partner strategy to support all operational functions of Medicaid Programs that meets or exceeds operational management goals, objectives and lead measures.
  5. Collaborate with vendor management team(s) to ensure acquisition of services required to support vendor strategy and ongoing relationship management, including adherence to all business and administrative regulations.
  6. Collaborate with Director of Compliance, Government Programs and Medicaid Compliance Officer, to ensure compliance with all business, administrative and relevant federal, State and local regulations.
Financial Management

  1. Lead financial performance P & L accountability of all Medicaid plans to meet membership, earnings and quality targets. Take appropriate actions to increase revenue, leverage resources, manage and/or minimize expenses and drive medical expense initiatives.
  2. Partner with HFHS and HAP Finance leaders to develop the annual fiscal operating budget to ensure financial goals and supporting operational objectives are met.
  3. Provide executive profit and loss (P&L) leadership, direction and operational oversight.
  4. Accountable for successful deployment of the budget to deliver required growth in membership, manage medical loss ratio and achieve quality and member satisfaction goals.
  5. Collaborate with a matrixed cross-functional team to identify opportunities to improve performance and develop plans to drive growth, manage medical cost and utilization and improve quality.
  6. Perform other related duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

  • Bachelor’s Degree required in related field; Master’s Degree preferred.
  • Minimum of ten (10) years of progressively responsible management experience in managed care insurance, finance, government, health care setting or related field.
  • Minimum of five (5) years of business unit leadership with P&L responsibility and a proven ability to drive membership growth and profitability.
  • Experience in Medicaid managed care.
  • Experience in at least one of the following: market strategy, network management, risk adjustment, Medicaid compliance or medical cost management.
  • Strong leadership skills, with experience in driving organizational alignment and change.
  • Experience in strategic management and execution of Medicaid strategy.

Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS’ Customer Service Policy and summarized below:

 Ÿ Communication         Ÿ Ownership       Ÿ Understanding           Ÿ Motivation     

Ÿ Sensitivity                   Ÿ Excellence       Ÿ Teamwork                  Ÿ Respect


Must practice the customer skills as provided through on-going training and in-services. Must possess the following personal qualities:

  • Be self-directed
  • Be flexible and committed to the team concept
  • Demonstrate teamwork, initiative and willingness to learn
  • Be open to new learning experiences
  • Accepts and respects diversity without judgment
  • Demonstrates customer service values

    Overview

       Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System is a

       $6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

       including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

       other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

       now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

       of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

       health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s  

       major academic medical centers, receiving between $90-$100 million in annual research funding and

       remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

       education and training, the health system has trained nearly 40% of physicians currently practicing

       in the state and also provides education and training for other health professionals including nurses,

       pharmacists, radiology and respiratory technicians. visit HenryFord.com.

     Benefits

       Whether it's offering a new medical option, helping you make healthier lifestyle choices or

       making the employee enrollment selection experience easier, it's all about choice.  Henry

       Ford Health System has a new approach for its employee benefits program - My Choice

       Rewards.  My Choice Rewards is a program as diverse as the people it serves.  There are

       dozens of options for all of our employees including compensation, benefits, work/life balance

       and learning - options that enhance your career and add value to your personal life.  As an

       employee you are provided access to Retirement Programs, an Employee Assistance Program

       (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness,                 and a whole host of other benefits and services.  Employee's classified as contingent status are not         eligible for benefits.    

      Equal Employment Opportunity/Affirmative Action Employer

        Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is

        committed to the hiring, advancement and fair treatment of all individuals without regard to

        race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

        weight, marital status, family status, gender identity, sexual orientation, and genetic information,

        or any other protected status in accordance with applicable federal and state laws.

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