Regional VP (COO) Medicaid-WI

Humana • Milwaukee, WI

4d • Hybrid

About The Position

Humana is seeking a Wisconsin Medicaid Regional VP, Market Operations (COO) to be responsible for the strategic development and oversight of operations for Humana’s Wisconsin Medicaid and Long-Term Care plan. This role is directly accountable for operational results in these areas and requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise wide. The individual will manage ongoing operations across multiple levels of the organization to meet operational contract requirements and financial performance goals. This role involves working with various internal groups such as Risk Management, Quality, Network, Member & Provider Services, Clinical, Analytics and Sales, and externally with Providers/Hospitals/Ancillary. The position is expected to drive optimization through strategic planning, addressing specific business performance issues across a matrixed organization, and fostering key relationships with business stakeholders. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes. The Regional VP, Market Operations (COO) will report directly to our Wisconsin Regional President.

Requirements

• Must reside in the state of Wisconsin.
• Bachelor’s degree in business, Operations Management, Healthcare Administration, or a related field.
• Must have Long Term Care (LTC) experience
• Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Long-Term Care (LTC) or State health care programs for the uninsured).
• 8+ years working in healthcare operations and/or oversight of health plan management, including several years working in a matrix environment.
• Deep technical and financial understanding of health plan operations, particularly Medicaid.
• 5 + years leading teams preferably of at least 5 direct reports, with proven success in expanding and elevating the capabilities and performance of the team.
• Working knowledge of relevant federal and state regulations and requirements pertaining to Medicaid and Long-Term Care.
• Advanced analytical and problem-solving skills.
• Ability to lead and manage special projects that may necessitate cross-functional partnerships.
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences.
• 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.

Nice To Haves

• Master’s degree in business, Healthcare, Public Health, or related field would be ideal.
• Reside in Madison or Milwaukee area

Responsibilities

• Designs, coordinates, and completes operational improvement projects across various functional areas within Humana to improve services, manage ongoing adherence to local, state, and federal regulatory and programmatic requirements.
• Manages daily operational of multiple levels of staff and multiple functions/departments across Humana to review and improve operational functions to ensure the execution of daily operating objectives and goals, including key performance metrics.
• Collaborates with the plan CEO and Executive Team on strategy and business planning to achieve business goals and maximize financial and customer performance.
• Leads Operations, plus matrix responsibility for other functional teams including but not limited to Billing and enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider Call Center, Provider Data Operations, and IT.
• Supports the development and execution of strategies to maximize growth, member retention, innovation, and member/provider experience for all products (Medicaid and Long-Term Care (LTC)).
• Owns business analysis and successful implementation of new contractual requirements.
• Partners with Contract Manager and Compliance Officer to manage process for timely and accurate regulatory reporting (non-financial) and updates to the Wisconsin Department of Health Services (DHS).
• Identifies and implements performance opportunities including those to improvement Member experience and Provider experience, efficiency, and accuracy.
• Informs and advises management regarding State current trends, and problems and activities to facilitate both short and long-range strategic plans to improve operational performance and enhance growth.
• Provides strategic leadership of provider network strategy to drive growth and performance, including oversight of Value Based Provider programs and MSO relationships.
• Delivers value to members by optimizing the member experience and maximizing new member growth and retention.
• Embeds health equity in all strategies involving member, provider, and community.
• Leads change and innovation by demonstrating emotional resilience managing change by proactively communicating the case for change and promoting a culture that thrives on change.
• Develops and cultivates a diverse and inclusive environment.
• Builds, leads, and develops a team of 15+ associates: coach and mentor associates with a goal of developing and retaining talent.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Executive