This position is responsible for directing the day-to-day Medicaid Operations & Care Delivery team focused on both internal and external initiatives to promote optimal care experience for members and patients in the applicable market. Responsible for integrating the work of internal functional areas, including care delivery, care coordination, utilization management, contracting, finance, community benefit, quality assurance, legal, regulatory as well as externally with public policy and community agencies, DHCS, Medi-Cal Plan Partners contracted relationships vendors, community leaders and others.

• Works closely with all national, shared service and applicable market leaders, including CA and HI Medicaid Health Plan Regulatory Implementation and Contract Management, care delivery and medical group leaders, to lead CA/HI Medicaid with implementation of regulatory and operational requirements.
• Responsible for the operations and performance of Care delivery and Care Coordination programs and initiatives for Medicaid and DSNP members and ensure that such programs and initiatives directly address non-medical and social needs; collaborate and work in partnership with both PMGs and the continuum administrators on Medicaid care management in collaboration with NCAL or SCAL/HI region.
• Leads statewide implementation of Medicaid regulatory requirements in collaboration with National Medicaid regulatory and policy teams.
  
• Partner with the applicable market operations, clinical, and community health leaders to ensure systems and processes are developed to ensure compliance.
• Develops strategy in collaboration with key stakeholders to include leadership from Region, Health Plan, Hospitals, Medical Groups, Community of Benefits, Finance, Public Affairs, Government Relations, Operations (i.e., regional and local area), Health Policy, Product and Market Management, and Local Area Leadership.
• Serves as the Plan Partner liaison and primary point of contact for the applicable market.
• Lead Memorandum of Understanding (MOU) development and implementation for each county where KP has a Medicaid presence.
  
• Ensure that governance processes are developed and in place for each county MOU and an engagement strategy in collaboration with community health is developed.
  
• Partner with National Medicaid Health Plan Regulatory Implementation and Contract Management team to ensure completion of MOU level deliverables.
• Coordinates Community Advisory Committees (CAC) as required by contract at the county/market/state levels to ensure engagement and representation of community stakeholders.
• Consults with and advises local area leadership to establish plans and initiatives including the financial, operations, and community benefit stakeholders.
• Oversees the health plan activities related to Medicaid and ensures that these programs are administered in compliance with all federal and state requirements for the applicable market.
• Performs regulatory oversight and accountability of member services, member onboarding program, and benefit implementation for the Medi-Cal population of the applicable market.
• Leads the program design and implementation of above programs, and partnering with KFH, KFHP, and PMG in CA/HI to ensure coordination and collaboration with clinicians.
• As necessary, identifies qualified vendors to augment our network of non-medical services for targeted member populations.
  
• Leads the development of associated contracts and oversees vendor relationships to ensure Kaiser Permanente’s quality and resource standards are being met or exceeded by our community partners.
• Oversees the development, implementation, tracking and analysis of Medicaid process improvement initiatives and related metrics for assessing Medicaid performance.
• Leads and coordinates relevant health plan, hospital, and medical group personnel to support Medicaid contract and strategy implementation and performance improvement.
• Builds a focused, coordinated effort to build and promote Kaiser Permanente’s brand and reputation through collaboration with National, California, PMG, local Medical Centers and other KP departments.
• Works in concert with the NCAL or SCAL/HI counterpart on standardizing Medicaid l specific policies and procedures for operations and care delivery for all of California.
• Works closely with the Vice President of California/Hawaii Medicaid Regulatory and Implementation and Executive Leadership to develop quality improvement and cost savings initiatives to ensure cross-functional integration and coordination of efforts.
• Conducts region-specific budget preparation and policy and program implementation of federal and state initiatives.
• Makes health plan and operational adjustments to guarantee that Medi-Cal programs are performing at or exceeding set targets.
• Provides management and oversight of contracted vendors for Medicaid.
• In partnership with the VP of California/Hawaii Medicaid Operations/Care Delivery, works to ensure that the infrastructure is in place to support the care delivery experience across the entire continuum for members and non-members, ensures detailed understanding of the performance for the Medi-Cal business line, and build relationships with our communities to help differentiate KP and strengthen our reputation as a health plan.
• Leads Medicaid Line of Business in the applicable market and ensures strong coordination/linkages across functional areas.
• Recognized as a champion and an advocate for advancing the Medicaid work, accountable or point person for communication, issue resolution, project management related to regional and/or CA/HI statewide Medicaid work.
• Conducts other duties as assigned by the Vice President of Medicaid Care Delivery/Operations- California/Hawaii.
• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures.

• Minimum of ten (10) years of relevant experience in healthcare, including leadership and management experience in health plan, hospital, medical group administration, Medi-Cal and government programs.

• Master’s degree in Business/ Finance/Economics/ Health Care Administration or related field.

• N/A

• Demonstrated ability to build consensus on strategies among leaders/peers/staff and across different reporting structures and entities.
• Able to drive executive teams and multidisciplinary groups.
• Demonstrated ability to lead significant organizational change initiatives and be strong representative/sponsor both externally and internally.
• Excellent interpersonal skills (negotiation, presentation, public speaking, listening and communication skills) characterized by effective interactions and strong working relationships with a diverse range of internal and external constituents, stakeholders and audiences.
• Experience in developing and implementing strategic plans, with particular interest/emphasis in Medi-Cal and State Programs.
• Ability to build and maintain relationships with external governments, agencies, clients and plan partners.
• Deep knowledge of overall health plan functions, including operations, finance, public affairs, care delivery, member services, community benefit, public affairs, claims, quality management and related regulatory services.
• Strong business acumen with excellent strategic and analytical thinking capacity.
• Demonstrated strong program and project management skills and implementation expertise.
• Demonstrated success in developing strong, collaborative relationships with key leaders to achieve goals.
• Expert understanding and the ability to demonstrate knowledge of federal and state health care laws, regulations affecting physician and non-physician practice, facility operations, health plan administration, political processes and legislative activity, financing and administration.
• Drives work through strong leadership, influencing skills and strong healthcare knowledge.
• Must be able to work in a Labor/Management Partnership environment.

• N/A

This role pays an estimated base salary of $229,500 to $286,875 plus incentive pay, robust executive benefits and relocation support for those who are eligible.

PrimaryLocation : California,Pasadena,Walnut Center - Regional Offices
HoursPerWeek : 40
Shift : Day
Workdays : Mon - Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE Executives|NUE|Non Union Employee
Job Level : Director/Senior Director
Job Category : Health Care & Hospital Operations
Department : Po/Ho Corp - RGNL Clrng-Southern CA Hosp - 0308
Travel : Yes, 15 % of the Time
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.