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Resp & Qualifications

This is an exciting opportunity to join our Government Programs team. We are looking for a DC-based Medicaid operator who is passionate about serving the community and ready to drive strategy to execution. This position will report to CareFirst BlueCross BlueShield Community Health Plan - Chief External Operations Officer.

PURPOSE:

The Director, Medicaid Operations provides leadership for the operation of a single jurisdiction Medicaid program including the strategic direction for the development and expansion the business, ensure the profitability, growth, and stability of the business. The Director will have responsibility for business direction, financial performance, growth strategy, product direction, and multi-year strategy necessary to deliver the overall strategic plan for a single jurisdiction Medicaid program. Through collaboration with matrix leaders in marketing, finance, government relationships, operations, health services and compliance, the Director will drive membership growth, financial performance, contractual compliance, and quality.

ESSENTIAL FUNCTIONS:

+ Develop and oversee implementation of annual business plan and their components of the 3 year strategic plan.

+ Establish the business objectives for all matrixed and direct functions supporting the business area as required to meet the business plan. Work with matrixed business leaders in these functions as they develop strategies to execute on these defined business objectives.

+ Establish business objectives for membership growth that deliver the business plan and strategic objectives. Integrate strategies that increase membership through alternative sources, outreach, education activities and strategic provider and community relationships.

+ Assess changes in the external environment including state and federal government, identify implications and develop plans to address.

+ Ensure strategic plans are translated into tactical goals, objectives and lead measures that guarantee performance measures are met or exceeded.

+ Design and develop appropriate products leveraging a government programs focused product team.

+ Develop and drive the strategic government programs marketing and communications plan, leveraging a marketing operations team to execute

+ Ensure strategic plans and customer experience strategy are translated into tactical goals, objectives and lead measures that guarantee operational objectives are met or exceeded.

+ Collaborate with cross functional leaders to identify and implement opportunities for improving operational performance.

+ Collaborate with vendor management team(s) to ensure acquisition of services required to support vendor strategy and ongoing relationship management, including adherence to all business and administrative regulations.

+ Collaborate with Medicaid Compliance Officer to ensure compliance with all business, administrative and relevant federal, state and local regulations.

+ Lead financial performance of plans to meet membership, earnings, and quality targets. Take appropriate actions to increase revenue, leverage resources, manage and/or minimize expenses and drive medical expense initiatives to deliver on the business plan.

+ Provide profit and loss (P&L) leadership, direction, and operational oversight.

+ Accountable for successful deployment of the financial plan to deliver required growth in membership, manage medical loss ratio and achieve quality and member satisfaction goals.

+ Collaborate with a matrixed cross-functional team to identify opportunities to improve performance and develop plans to drive growth, manage medical cost, improve operational costs, and improve quality.

QUALIFICATIONS:

**Education Level:** Bachelor's Degree

Experience:

+ 13 years experience in Medicaid or Medicare managed care, managed care insurance, finance, government, health care setting or related field.

+ 5 years progressively responsible management.

+ DC Managed Care experience.

**Preferred Qualifications** :

+ Master's Degree

Key Skills & Abilities:

+ Advanced analytical and financial modeling skills, problem solving, planning and financial and accounting skills

+ Develops effective relationships with internal and external colleagues, clients and vendors to ensure that operations programs are aligned with corporate and strategic objectives.

+ Ability to develop and implement policies and programs that will advance corporate, financial and operational goals and objectives

+ Strong analytical and critical thinking skills. Ability to organically offer perspectives and insights.

+ Extremely well developed organizational and prioritization skills as well as strong process orientation skills.

+ Highly developed written and oral communication skills to effectively convey complex and detailed concepts to a diverse audience and facilitate communication between different areas of the corporation.

+ Considerable judgment, tact, initiative, accuracy and integrity. Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.

+ Demonstrated ability to establish credibility with executives and senior management.

+ Must be a strong values driven leader and a collaborative team member able to engage colleagues from all levels of the organization

Salary Range: $146,080- $246,510

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Leadership - Medicaid & Medicare

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

\#LI-KL

REQNUMBER: 20976