Director of Medicaid

Accountable for the overall performance of Medicaid, Medi-Medi “dual eligibles,” Child Health Plan and other public programs in which Kaiser Permanente participates. Delivers on the region’s goals for growth and staying within allocated community benefit budget. Strategically plans, directs, manages and oversees operations for this line-of-business. Accountable for creating a culture of compliance, ethics and integrity. Maintains knowledge of and assures departmental compliance with Kaiser Permanente’s Principles of Responsibility and policies and procedures, and applicable regulatory requirements and accreditation standards. Responds appropriately, including required reporting, to observed fraud or abuse.

Essential Responsibilities:

    • Performs business systems analysis and membership forecasting. Monitors profit and loss, implements and oversees health disparity and disease management programs, work process effectiveness and efficiency, captures costs and ensures effective billing processes and member service, to include efficient and accurate enrollment and eligibility, contract development and management, coordinating financial and actuarial analyses of revenue and costs for public programs, and community benefit tracking for government lines-of-business.
    • Articulates and sequences line of business (LOB) strategies and tactics in a three (3) year business plan and refreshes the plan periodically as market, government, community benefit and other conditions evolve. Supervises assigned staff. Leads an internal stakeholder team for this line-of-business to develop strategic plans and improve operations.
    • Establishes and maintains good working relationships with internal partners and appropriately involves experts in other areas of the organization to develop and refine LOB plans.
    • Directs, manages and guides internal and external entities related to the line-of-business, including contracting with the state, analyzing program specific performance data, analyzing state reconciliation, and establishing and implementing plans to achieve strategic goals and key program success indicators.
    • Builds and sustains effective relationships with the Colorado Department of Health Care Policy and Finance, the Colorado Division of Insurance and the Colorado Department of Public Health and Environment as appropriate.
    • Monitors performance of the LOB and ensures that required metrics are included in, updated and reported in all relevant management tools, e.g. Active Strategy. Partners with Community Benefit and other LOBs to develop processes and analyses that support growth activities and meet community benefit goals.
    • Ensures communications planning is in concert with ICBM for OGP LOBs. Directs, influences, supports, problem solves and does QA for operational departments that support business requirements and operations of government LOBs.
    • Oversees implementation of complex operational components of government programs, including financial tracking and reporting (P/L), benefit design, eligibility, and medical office and pharmacy operations.
    • Coordinates financial and actuarial analyses of revenue and costs for government LOBs and recommends renewal, modification or termination of plans to leadership.

Basic Qualifications:

Experience

    • Minimum eight (8) years of management experience required.
    • Minimum ten (10) years of relevant health care or closely related progressive experience required.
    • Minimum five (5) years of experience administering public benefit programs or with health care safety net, including  experience administering government contracts and services to government beneficiaries or vulnerable populations required.
      Education
    • Bachelor’s degree in health administration, business administration, or related field required.
      License, Certification, Registration N/A

Additional Requirements:

    • Strong collaboration, communication and presentation skills required.
    • Extensive experience with State Medicaid agencies required.
    • Computer proficiency with word processing, spreadsheet and presentation software required.
    • Ability to establish and maintain good working relationships with internal partners required.
    • Experience in leading and the development of staff required.
    • Strong analytic skills required.

Preferred Qualifications:

    • Experience directing and managing lines of business, including government lines, within a health care organization preferred.
    • Master’s degree in health administration, business administration, or related field preferred.

To apply for this position, please contact Stephanie Price at stephanie.price@kp.org.