medicaid plan president - Tallahassee, FL, United States - Sentara Healthcare

Description

City/State

Tallahassee, FL

Overview

Work Shift

First (Days) (United States of America)

Sentara Health is recruiting a Florida Medicaid Health Plan President to work Onsite in Florida

The Vice President and Medicaid Health Plan President for Sentara Care Alliance, a service of Sentara Health Plans, is the visionary leader responsible for the long-term success and sustainable growth of our Florida-based organization providing vital health coverage to Florida's Medicaid beneficiaries.

This critical role requires a passionate advocate for health equity, coupled with strategic expertise in navigating the complexities of Florida's Medicaid program and leading the organization through dynamic regulatory and healthcare environments.

The ideal candidate will champion the needs of our members while cultivating strong partnerships with state officials, providers, and community organizations.

Key Responsibilities:

• Strategic Leadership: Develop and implement a strategy for the health plan's growth and success, ensuring alignment with Florida's Medicaid program regulations and addressing the unique needs of the underserved population.
• Medicaid Expertise: Possess a deep understanding of Florida's Medicaid program framework, including eligibility criteria, financing models, provider network management, and program regulations.
• Operational Excellence: This position involves leading a management team of direct reports and shared services staff and managing within a matrix environment. This position is accountable for all aspects of plan operations, ensuring quality, cost-effectiveness, and a positive member experience.
• Financial Oversight and Sustainability: Oversee the financial health and sustainability of the Medicaid plan. Manage budgets, revenue projections, resource allocation and ensure fiscal responsibility and compliance with regulations.
• Advocacy and Collaboration: Advocate for Medicaid program improvements and access to quality healthcare for underserved communities. Collaborate with government agencies, community stakeholders, and healthcare providers to enhance program effectiveness.
• Member Services Excellence: Ensure exceptional member experiences and satisfaction. Lead efforts to address member concerns, resolve issues promptly, and provide accessible support resources.
• Compliance and Policy: Ensure strict adherence to all federal and Florida state Medicaid regulations, including data privacy and security measures. Proactively monitor legislative changes and adapt strategies accordingly.
• Growth and Innovation: Actively pursue growth opportunities through market expansion.
• Public Image: Serve as the public face of the organization, fostering community partnerships and engaging media to promote the importance of Medicaid and its role in improving public health outcomes.

Qualifications:

Education:

• Bachelor's degree in related field required
• Master's degree in Business Administration, Public Health, Healthcare Administration, or a closely related field preferred

Experience:

• 10+ years of progressive leadership experience in the healthcare industry, with a minimum of 5 years at a senior executive level within a Medicaid managed care environment.
• Demonstrated success in strategic planning, financial management, operations optimization, and regulatory compliance.
• Thorough understanding of Florida's Medicaid program, policies, and healthcare delivery systems.
• Exceptional communication, interpersonal, and negotiation skills, with the ability to build trust and consensus among diverse stakeholders.
• Unwavering commitment to promoting health equity, addressing social determinants of health, and improving the health and well-being of Medicaid beneficiaries.

Job Summary

The Medicaid Plan President is Sentara's expert resource regarding the MLTSS beneficiaries.

The Medicaid Plan President provides leadership and Medicaid long term services and supports expertise to Sentara Health Plans' clinical, provider network, marketing, operations and quality department staff as it relates to MLTSS.

Ensures appropriate prioritization of initiatives and resource management to fulfill program goals.

Bachelor's degree in related field required, Master's Degree preferred. Minimum of 5 years' experience in or with Medicaid, disability related programs and/or Long Term Services & Support required. Minimum of 5 years' experience working with Federal and State policy initiatives related to Medicaid populations required. Proven success in leadership of program management, execution and development. Proven success building and leading a cross-functional team

Florida Medicaid Health Plan President


Location:
Florida


Reports To:
Senior Vice President, Government Programs

Summary:

The Vice President and Medicaid Health Plan President for Sentara Care Alliance, a service of Sentara Health Plans, is the visionary leader responsible for the long-term success and sustainable growth of our Florida-based organization providing vital health coverage to Florida's Medicaid beneficiaries.

This critical role requires a passionate advocate for health equity, coupled with strategic expertise in navigating the complexities of Florida's Medicaid program and leading the organization through dynamic regulatory and healthcare environments.

The ideal candidate will champion the needs of our members while cultivating strong partnerships with state officials, providers, and community organizations.

Key Responsibilities:

• Strategic Leadership: Develop and implement a strategy for the health plan's growth and success, ensuring alignment with Florida's Medicaid program regulations and addressing the unique needs of the underserved population.
• Medicaid Expertise: Possess a deep understanding of Florida's Medicaid program framework, including eligibility criteria, financing models, provider network management, and program regulations.
• Operational Excellence: This position involves leading a management team of direct reports and shared services staff and managing within a matrix environment. This position is accountable for all aspects of plan operations, ensuring quality, cost-effectiveness, and a positive member experience.
• Financial Oversight and Sustainability: Oversee the financial health and sustainability of the Medicaid plan. Manage budgets, revenue projections, resource allocation and ensure fiscal responsibility and compliance with regulations.
• Advocacy and Collaboration: Advocate for Medicaid program improvements and access to quality healthcare for underserved communities. Collaborate with government agencies, community stakeholders, and healthcare providers to enhance program effectiveness.
• Member Services Excellence: Ensure exceptional member experiences and satisfaction. Lead efforts to address member concerns, resolve issues promptly, and provide accessible support resources.
• Compliance and Policy: Ensure strict adherence to all federal and Florida state Medicaid regulations, including data privacy and security measures. Proactively monitor legislative changes and adapt strategies accordingly.
• Growth and Innovation: Actively pursue growth opportunities through market expansion.
• Public Image: Serve as the public face of the organization, fostering community partnerships and engaging media to promote the importance of Medicaid and its role in improving public health ou

* Qualifications:Education:

• Bachelor's degree in related field required
• Master's degree in Business Administration, Public Health, Healthcare Administration, or a closely related field preferred

Qualifications:
BLD - Bachelor's Level Degree (Required), MLD - Master's Level Degree

Government Program Operations, Health Insurance Plans, Medicaid, Related

Skills

Active Learning, Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Learning Strategies, Marketing, Mathematics, Mgmt of Financial Resources, Mgmt of Material Resources, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Negotiation, Persuasion, Project Management, Quality Control Analysis, Reading Comprehension, Science, Service Orientation {+ 7 more}

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce.

Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at for further information.

In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission to improve health every day, this is a tobacco-free environment.