VP-Medicaid

Presbyterian Healthcare Services

3d•Remote

About The Position

Presbyterian Health Plan (PHP) seeks to remain a national leader in serving the complex and diverse needs of Medicaid members and in working with State and Federal agencies to design and implement new and innovative programs and services to meet the unique needs of this population. Position reports to the President of PHP and is accountable for all aspects of our Medicaid program, including serving as the sole Contractor for Children in State Custody. Provides strategic and thought leadership, including best practices, emerging practices, and innovations, on a national scale, intentionally connected to a deep understanding and solutioning for the needs of New Mexicans across diverse communities, including rural, frontier, Native American sovereignties, and urban centers. The Medicaid program includes provisions for all physical, behavioral health, and long-term services and supports (LTSS) for Medicaid members, including dental, vision, pharmacy, etc., and the full spectrum of social determinants of health, including transportation, to support health equity across and within our unique populations. The position offers an exciting opportunity to lead and shape Medicaid programs that have a significant impact on the health and well-being of vulnerable populations. The ideal candidate will possess a combination of strategic vision, operational expertise, leadership skills, and government relations experience to drive positive outcomes and advance the Presbyterian mission of ensuring all our members can achieve their best health.

Requirements

Bachelor’s degree in healthcare administration, public health, business administration, or related field.
Extensive experience (10+ years) in healthcare management, with a focus on Medicaid programs.
In-depth knowledge of the full array of Medicaid programs, regulations, policies, best practices, and emerging innovations at the Federal and State levels.
Extensive government relations experience is required, preferably within the New Mexico market.
Strong leadership skills with a proven track record of driving organizational change and achieving results through influencing and collaboration.
Excellent communication, negotiation, and relationship-building skills.
Strategic thinker, ability to analyze complex issues, and develop innovative solutions.
Demonstrated ability to collaborate effectively with diverse stakeholders and manage cross-functional teams.
Experience in budgeting, financial management, and performance measurement.
Commitment to equity, diversity, and inclusion

Responsibilities

Developing and executing strategic plans that meet the needs and expectations of Medicaid members, relevant State of New Mexico agencies including the Healthcare Authority (HCA) and Children, Youth and Families Department (CYFD), CMS and key stakeholders.
Forming, collaborating with and leading diverse teams across PHP, to ensure effective delivery of Medicaid services while maintaining compliance with regulations and achieving organizational strategies, goals and metrics, as well as the strategies, goals and metrics of HCA and CYFD.
Providing ongoing surveillance of national and state market changes and developments to ensure that PHP remains competitive and viable in the future.
Leading the design, development and enhancement of Medicaid programs to meet the evolving needs of beneficiaries and stakeholders, to include for example, evidence-based models applicable to unique populations such as those specific to Children in State Custody and Behavioral Health.
Provide thought leadership and input on the State’s strategy for achieving their vision and objectives and fostering alignment with Presbyterian’s capabilities and new business models, to include for example improving access to behavioral health and substance use disorder services and supports and expanding availability of models and services to serve Children in State Custody.
Overseeing day to day operations for Medicaid programs working in collaboration with executive leaders and operational leaders.
Leading functional teams to serve our Medicaid members and meet and exceed the needs and expectations of stakeholders without direct reporting relationships, to include for example, network contracting and development, claims, population health inclusive of pharmacy, etc.
Aligning Medicaid to the Dual Special Needs Plan (D-SNP) requirements to support optimal performance and outcomes.
Proactively monitoring changes in Medicaid waivers, state plan amendments, policy and legislation to mitigate risks, inform strategies, and maintain program integrity.
Engaging fully in the government relations process to influence a positive perception of PHPs Medicaid program.
Provide strategic direction and alignment with key stakeholders over quality initiatives to improve the quality, efficiency and effectiveness of Medicaid services, including performance measures, outcome evaluation, and continuous process improvement.
Establishing and overseeing strategic workstreams and deliverables, scorecard metrics including quality, experience, and financial measures, to measure achievement of effective outcomes while maximizing value for members and stakeholders.
Build and maintain relationships with key stakeholders, including government agencies, healthcare providers, advocacy groups, community organizations, and policymakers.
Develop and lead high performing teams, providing leadership, guidance and mentorship over a high-functioning team fostering a culture of accountability, innovation, and excellence.
Leads all Medicaid procurement activities including ongoing market and technology assessments, preparation efforts and resource planning, market positioning, consultant sourcing, marketing and branding, and the response development cycle