President and CEO, MediGold

Trinity Health•Columbus, OH

About The Position

The President and CEO of MediGold provides leadership, direction, and management for MediGold’s Medicare Advantage HMO and health insurance products in all states where it operates. The role is responsible for strategy, medical delivery networks, Medicare bid development, government programs, risk adjustment, operations, sales and marketing, medical management, quality, finance, actuarial functions, and shared responsibility for legal, IT, and compliance. The President reports to the Trinity Health Executive accountable for MediGold, the Trinity Health EVP, Chief Operating Officer, and works with that executive to develop and recommend strategies for county expansion, bid development, annual AEP marketing, and MediGold’s overall strategic direction. MediGold is a provider-sponsored Medicare Advantage organization within Trinity Health. Through Mount Carmel Health System, it integrates insurance and care delivery and focuses on value-based care, coordinated population health management, Medicare risk performance, and a mission-driven approach to serving members through comprehensive Medicare Advantage products. The President develops and executes MediGold’s strategic direction, translates the strategic plan into operational actions and results, and implements policies and operating practices approved by the Plan Board of Directors or required by regulation. The role leads staff recruitment and development, builds an engaged leadership team, and oversees operational and capital budgets, annual and long-range plans, expenditures, and financial plans for profitable growth. It also develops relationships with community, provider, regulatory, governmental, and industry stakeholders and advocates effectively with those stakeholders. The position advances clinical and financial integration with Mount Carmel, Trinity Health Clinically Integrated Networks, medical groups, providers, and other health systems. It develops capabilities to monitor risk-based arrangements and provider incentives, supports high-quality, connected care at lower total cost, and pursues strong STAR ratings. The President directs Marketing, Finance, Health Services, and Operations; oversees strategic information systems and business process outsourcing contracts; and develops technology strategy, including appropriate use of artificial intelligence. The role also oversees regulatory compliance, Board and regulatory communications, service quality, payment integrity, growth infrastructure, community visibility, and relationships with regional health ministry and Trinity Health leaders. The position requires adapting to frequently changing work priorities and travel as needed to Trinity Health sites. The President is expected to demonstrate Trinity Health’s Mission and Core Values, including reverence, commitment to people experiencing poverty, justice, stewardship, integrity, and safety. Trinity Health is an Equal Opportunity Employer.

Requirements

Bachelor’s degree.
At least ten years of progressively responsible leadership experience in a relevant health plan.
Executive-level health plan management experience, including oversight of growth, operations, and financial results.
Track record of increasing revenue and profits.
Experience in matrix management.
Significant Medicare Advantage experience.
Effective communication skills.
Strong business acumen.
Unquestionable integrity.
Experience managing risk partners, including at-risk provider groups.
Ability to adapt to frequently changing work priorities.
Ability to travel as needed to various Trinity Health sites.

Nice To Haves

Master’s degree preferred.
Experience working in a health plan that is part of an integrated delivery system preferred.

Responsibilities

Develop and execute MediGold’s strategic direction in conjunction with the Trinity Health EVP, Chief Operating Officer.
Translate the MediGold strategic plan into operational actions and results through culture, people, processes, and technology.
Implement policies, plans, and operating practices approved by the Plan Board of Directors or required by state regulations and statutes.
Recruit, develop, support, and direct Plan staff; build and motivate an engaged leadership team aligned with Mount Carmel Health and Trinity Health values.
Develop and administer operational and capital budgets, annual and long-range plans, and financial plans that support profitable growth.
Maintain relationships with community groups, provider agencies, regulatory and governmental agencies, and other local and national organizations; advocate with governmental and industry stakeholders.
Develop processes to monitor performance under risk-based arrangements and create provider incentives based on outcomes.
Advance clinical and financial integration with the health system, Trinity Health Clinically Integrated Networks, medical groups, providers, and other health systems.
Oversee expenditure of funds within budget guidelines approved by the Board of Directors and Trinity Health.
Direct Marketing, Finance, Health Services, and Operations, and provide leadership to providers, physicians, and hospitals participating in the Plan.
Provide effective communications and prepare business status reports for the Plan Board of Directors and regulatory agencies; identify recommendations requiring Board action.
Maintain a consistent focus on quality care and member services, employee satisfaction, and STAR ratings.
Oversee strategic information systems and Business Process Outsourcing contracts, service quality, payment integrity, and technology strategy, including appropriate use of artificial intelligence.
Develop organizational infrastructure to support plans and objectives for growth and expansion.
Build partnerships and maintain communication with regional health ministry executives and Trinity Health leaders; participate in MCHS leadership meetings.
Participate in community organizations and activities to raise MediGold and MCHS visibility; champion the Plan and its provider partners.
Direct and assure compliance with state and federal regulations in partnership with MCHS and Trinity Health Compliance leaders.
Work effectively with internal and external stakeholders, including auditors, regulators, customers, and colleagues.
Promote a Culture of Safety by adhering to policies, procedures, and plans that prevent workplace injury, violence, and adverse outcomes.
Develop relationships outside the immediate service area to ensure the Plan responds to outlying partner providers’ needs.