We are looking for a dynamic and visionary SVP, Medicaid Operations to lead a team of executives focused on Clinical Operations, Account Installations, Provider Experience and Medicaid Transformation. This executive role includes overseeing and optimizing our service delivery model, ensuring compliance with regulatory standards, and driving process improvements to enhance efficiency as well as state partner and member satisfaction. The ideal candidate will lead these functions while driving sound approaches to healthcare delivery.

• Sets the vision and strategic plan for Segment Operations and oversees all operations within Medicaid, including but not limited to:
  • Centralized Clinical Operations
  • New Market Stand up and Operationalization
  • Business Intelligence and reporting to state partners
  • Compliance for contractual obligations across all Medicaid Markets
  • Oversight and support of all Market operational functions
  • Policies, procedures, training, and education for all operations functions
• Ensures integration of clinical functions across centralized, market teams and internal and external partners
• Leads the compliance function for operational quality assurance and provides strategic insight and oversight of key contractual obligations and guidance, partners with Corporate Affairs on proposed and final rules and legislation, support regulation impacts to existing programs and helps to ensure any new program changes are implemented with changing regulatory landscape
• Develops the vision and strategic plan for integrated clinical care for the Medicaid Segment. Responsible for the experience of members and providers
• Sets the vision and strategic plan for prospective programs to drive operational excellence and repeatability across markets
• Drives the development of internal capabilities, KPIs, Dashboards, etc to manage plan performance
• Develops scalable operational programs through pilots, evaluations and measurable outcomes
• Serves as a key leader/support for Medicaid Market Leadership, including Operations AVPs, Market CEOs, and Divisional Presidents.
• Leads a team of approximately 6 direct reports, including VPs, AVPs, and Directors with more than 200+ associates in the organization. Develops the talent and fosters a culture to meet and exceed results.

Medicaid Account Installation

• End to end implementation of new Medicaid programs, including accountability to deliver aligned and successful efforts for all enterprise partners
• Drive Operational Quality Assurance efforts to ensure Medicaid compliance, including a Medicaid Compliance Committee, State Reporting and shared services oversight and governance
• Oversee Medicaid Market Model Deployment, readiness execution, training and hiring efforts for all market functions following an award
• Deliver Market focused business intelligence that drives aligned market KPIs through the development and deployment of Market focused scorecards

Clinical Operations

• Manage clinical operations centralization efforts, maintaining a consistent approach to the Medicaid Clinical Model
• Ensure high-quality care delivery and compliance with clinical guidelines, supporting contractual requirements and exceptional health outcomes for members
• Responsible for the oversight and delivery of clinical technology across platforms for the Medicaid markets
• Guide and support the Integrated Plan Operating Model through the development of Long-Term Services and Support (LTSS) Plan strategy
• Lead and manage a high-performing operations team, fostering a culture of excellence and accountability

• Bachelor’s degree in healthcare administration, business, or a related field. 10 plus years in the healthcare industry, specifically in Medicare or Medicaid operations, Finance or other similar functions with a proven track record of driving quality, financial and operational performance.
• Expertise in the development and execution of strategy, along with a record of success working in a highly matrixed environment.
• 8 plus years of people leadership with proven success in expanding and elevating the capabilities and performance of a multi-level team and large-scale organization.
• Understanding of how organization capabilities interrelate across segments and enterprise-wide
• Deep knowledge of the health insurance industry, competitive landscape, Medicaid operations end-to-end and a keen respect for compliance and legal guidelines
• Solid finance acumen and understanding of the compensation arrangements between health plans and providers
• Proven ability to manage the complexity of competing priorities
• Record of success in leading large-scale, multi-function operations organizations
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences, both internally and externally
• Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome, particularly in scenarios that call for “tough conversations” to be conducted
• Location: Tampa, FL or Louisville, KY are highly preferred locations.

Preferred Qualifications

• Master’s degree
• Experience with platform migration, system operations and agile, strongly preferred