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Vice President, Medicaid Programs

Company: PacificSource
Location: Salem
Posted on: May 3, 2021

Job Description:

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: This position is a member of the PacificSource leadership team and, together with the EVP-Lines of Business, is responsible for driving success in the company's Medicaid line of business. This includes ensuring the organization accomplishes its goals around quality, cost, and health improvement on behalf of its Medicaid members. The position leads both internal teams (both direct and dotted-line reporting) and external partners in aligning strategic planning efforts, resource allocation, and management objectives to enhance PacificSource's Medicaid line of business. The VP of Medicaid Programs helps PacificSource emerge as a nationally recognized leader in a rapidly changing health reform environment by informing state-level policy making, participating in community and consumer driven governance models, leading multi-stakeholder strategic planning efforts, and effectuating internal work plans. The VP is considered the line of business leader with responsibility for PacificSource's Coordinated Care Organizations (CCOs), the Integrated Delivery System within Health Share of Oregon, and other Medicaid activities in the broader PacificSource service area.

Essential Responsibilities:

Business and Operating Objectives

  • Develop strategic business partnerships with state and local government, providers, agencies, and internal PacificSource leaders to ensure priority Medicaid objectives are consistently accomplished.
  • Lead internal Steering Committees and work groups tasked with monitoring end-to-end performance of PacificSource Medicaid line of business, and developing action plans for underperforming areas. These include financial and operating performance, quality of care, member engagement and satisfaction, provider access and engagement, health care transformation efforts, contractual deliverables, and compliance.
  • Build/maintain relationships with PacificSource's Medicaid community governance partners, providers, community leaders, and other external stakeholders. Align PacificSource and community partner interests toward the accomplishment of common, community level health outcomes.
  • Build and maintain relationships with key departments and personnel within regulatory agencies, including state Medicaid agencies, governors' offices, and other entities with oversight or influence on state Medicaid programs.
  • Inform and guide state Medicaid policy development by ensuring adequate company participation in committees and workgroups.
  • Assume a central role in working with providers, county health departments, regulatory agencies, and other partners to orchestrate care model improvements for individuals enrolled in Medicaid delivered by PacificSource.

Development and growth opportunities

  • Monitor and participate in managed Medicaid development and growth opportunities, including in PacificSource markets outside Oregon.
  • Strategize growth and business development opportunities for the Medicaid line of business and lead implementation of any resulting product, benefit, operating, and provider network changes.
  • Closely monitor healthcare policy and legislative developments, as well as decisions within the key agencies that impact the Medicaid line of business. Translate the impact of policy decisions to the organization; lead communication, planning, and implementation efforts required for the organization to respond to policy changes in a timely manner.
  • Ensure internal PacificSource operations synergize with the core competencies of external community partners. Improve Medicaid member experience and quality of care by effectively leveraging both PacificSource's core competencies and those of its partners.
  • Lead all PacificSource efforts associated with Medicaid procurement. Partner with other executives and subject matter experts to craft procurement strategies and value propositions. Execute on procurement requirements and oversee corresponding implementation of new contracts.
  • In partnership with regional Vice Presidents and other executive leadership, design and implement new or improved community governance models to meet PacificSource and community needs.

Internal and External Collaboration

  • Engage in PacificSource's community governance model by participating on local Health Council Boards, standing committees, and ad hoc committees.
  • Collaborate closely with the VP of Government Relations and other subject matter experts regarding legislative initiatives and communication with state representatives.
  • Work closely with the Chief Compliance Officer to ensure internal performance and policies and procedures are in alignment with state and federal legislation.

Internal Alignment and Leadership Engagement

  • Align company level and functional/departmental priorities with Medicaid line of business priorities to enhance Medicaid performance and accountability. Work directly with department leaders to ensure knowledge, priorities, and actions ultimately accomplish line of business aims on behalf of PacificSource members and community partners. Maintain collaborative partnerships with key departments and leaders.
  • Actively engage and inform the Executive Management Group on Medicaid performance, developments, and growth opportunities
  • Actively participate as a key team member in company leadership meetings.
  • Actively participate in various strategic and internal committees in order to disseminate information within the organization, represent company philosophy, and preserve visibility within the community.

Leadership:

  • Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
  • Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize methodologies that promote continuous improvement. Utilize appropriate tools and strategies to monitor key performance indicators and identify improvement opportunities.
  • Actively participate as a key team member in manager meetings.

Supporting Responsibilities:

Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned.

Work Experience: Minimum of ten years' experience in the health insurance industry, specifically health policy and line of business leadership. Managed Medicaid experience required. Five years in a significant leadership role is required. Experience building and implementing Medicaid business development strategies is required. Experience leading Medicaid performance for plans across multiple markets and interacting with diverse Medicaid programs is strongly preferred.

Education, Certificates, Licenses: Bachelor's degree required with preferred focus in business, health care administration, public health, or clinical; Masters preferred

Knowledge: Effectively present information to and respond to questions from a variety of groups, including staff, management, boards of directors, employees and community stakeholders. Knowledge of strong consensus building and inclusive/non-consensus solution building. Ability to create synergy by facilitation collaboration among independent entities. Comprehensive knowledge of business principles and techniques of administration, organization and management. Health care leadership, planning and development experience with in-depth understanding of health care issues and trends. Comprehensive understanding of key issues existing in the health care industry. These include but are not limited to: federal, state, and local policies and trends in the healthcare industry.

Competencies

  • Authenticity
  • Building Organizational Talent
  • Coaching and Developing Others
  • Cultivating Networks
  • Customer Focus
  • Empowerment/Delegation
  • Emotional Intelligence
  • Establishing Strategic Direction
  • Leading Change
  • Optimizing Diversity
  • Passion for Results

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required between various offices and locations primarily in Oregon, Idaho, Washington, and Montana approximately 40% of the time.

Our Values

  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Keywords: PacificSource, Salem , Vice President, Medicaid Programs, Other , Salem, Oregon

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