ED, Medicaid Hawaii

Reporting to the National Senior Vice President of Medicaid, with accountability to the Regional President of the Hawaii region, the Executive Director of Medicaid, Hawaii is a key leader of the Medicaid national line of business and responsible for leading, managing and/or coordinating KPs Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships and related activities in 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 Hawaii and for all KP regions. The position includes similar responsibilities for state D-SNP functions, in collaboration with KPs Medicare line of business leaders. The Executive Director 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 the Hawaii Permanente Medical Group, serving Hawaii.

• Lead, manage and coordinate strategy, planning, health plan operations, compliance, regulatory and industry relationships, and related activities in Hawaii.
• Work closely with all national, shared service and HI market leaders and other care delivery and medical group leaders to support HI with implementation of the strategy, regulatory and operational requirements.
• Lead, manage, mentor, and develop Medicaid and D-SNP leaders and staff in Hawaii and across the KP program to provide the subject matter expertise to support the market and shared services with implementation of Medicaid and D-SNP regulatory requirements.
• Maintain a deep understanding of current and potential state and Federal Medicaid, CHIP, D-SNP and related legislation and regulations, and their impact on KP Medicaid strategy, operations, and performance.
• Monitor and maintain a deep understanding of the national, 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 and D-SNP participation strategies in Hawaii. Coordinate and align regional Medicaid and D-SNP strategy development and plans with regional and national line of business, care delivery and functional strategies and policies.
• Collaborate with regional and national government relations to monitor and influence legislation and regulation related to Medicaid and D-SNP. Develop and execute legislative, regulatory and advocacy strategies to assure adequate payment levels and efficient regulation for Medicaid and D-SNP plans and providers.
• Collaborate with National Medicaid Compliance to ensure all KP functions are aware of and compliant with state and Federal Medicaid and D-SNP 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 and D-SNP lines of business.
• Collaborate with regional and national finance, including Medicare and Medicaid finance, to monitor and help manage financial performance.
• Implement ongoing changes to Medicaid and D-SNP organizational structure, staffing and processes to improve effectiveness and efficiencies.
• Monitor, collaborate and support initiatives to improve financial performance of the Medicaid and D-SNP lines of business.
• Responsible for the management of KP relationships with the States Medicaid agencies.

Qualifications:

• Minimum twelve (12) 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.
• Minimum five (5) years of prior healthcare leadership experience, including Medicaid and other State Sponsored programs.

• BA in business or related areas required

• N/A

• Extensive knowledge and expertise in Medicaid, CHIP, and D-SNP
• Demonstrated experience and success in health plan and/or care delivery operations and business development in Medicaid Managed Care.
• Understanding of KP 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.

• Experience in health care management and the Medicaid regulatory environment in Hawaii is preferred.
• Experience working with State Medicaid agencies on innovative models as well as negotiating contracts and rates is preferred.
• Experience in D-SNP, Medicare Advantage or in programs serving dual eligible preferred.
• Masters Degree preferred.

Salary : $243,000 - $303,750