Highmark Health Director of WV Medicaid Operations in Parkersburg, West Virginia
Highmark West Virginia Inc.
Job Description :
This job directs and manages the WV Medicaid programs as required within the state’s Medicaid contract and in response to direct inquiries from the state regulators. The incumbent will be readily available to the state regulator for both planned and ad hoc meetings, reports and requests. Will work collaboratively with multiple stakeholders and various cross-functional teams, locations and departments to meet or exceed state contractual performance requirements, overall profitability, member satisfaction and state regulator satisfaction. Lead efforts to capture plan performance, work with vendor partners to identify opportunities for improvement. Work with vendor partners to design, implement and execute strategies and work with cross-functional clinical, pharmaceutical, operational, IT and other teams to ensure overall goals of the organization are met and to optimize outcomes. The incumbent will collaborate with the organization’s government markets and Medicaid leadership committees to ensure that new programs and projects are aligned to divisional and corporate strategic objectives and direction. The incumbent will be responsible for meeting or exceeding all state regulatory contractual requirements and to help achieve the Organization's overall performance objectives. The incumbent will be responsible for escalating cross-portfolio dependencies, project risks, and items for management attention to the executive leadership group.
• Manage and oversee the state’s managed care organization (MCO) contractual performance as specified in the contract and to help achieve the Organization's goals and objectives.
• Partner with external vendors in the management of a portfolio of key initiatives through a disciplined, customer focused, program management approach; identifies and resolves project and program issues and risks.
• Manage and review performance metrics, compliance standards, policies, and procedures; monitor implementation of remediation steps and corrective action plans necessary to address compliance issues and risks.
• Develop and maintain local and state relationships and affiliations, which promote the success of the organization’s business interests.
• Other duties as assigned or requested.
Bachelor's Degree - Business, Marketing, Health Administration or related field
Prior Medicaid managed care leadership experience
Master’s Degree - Business or Health Administration
• 10 - 15 years' healthcare payer (insurance) or related experience
• 10 - 15 years' experience in an operations area
• 5 - 7 years' in a program oversight management/executive role
• 5 - 7 years' experience supporting internal and/or external regulatory audits
KNOWLEDGE, SKILLS & ABILITIES
• Leadership experience in functional and matrix aligned organizations
• Previous consulting in a principle/manager/director role; portfolio management experience
• Strong communication and interpersonal skills; software development life-cycle methodology
• Strong understanding of portfolio management methodology
• Medicaid experience is required
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Highmark Health and its subsidiaries and affiliates comprise a national health and wellness organization that employs more than 40,000 people and serves nearly 50 million Americans in all 50 states and the District of Columbia. The organization includes businesses in health insurance, health care delivery, managed vision care, retail eyewear and eye care services, eyewear manufacturing, dental solutions, health risk solutions, and innovative, technology-based solutions. Highmark Health is the parent of Highmark Inc., Allegheny Health Network, HM Health Solutions, and HM Home and Community Services LLC.