JOB SUMMARY
The Senior Vice President (SVP) of Medicaid is responsible for the overall strategic direction, financial performance, and operational execution of Highmark's Medicaid & D-SNP business. This executive leadership role requires a deep understanding of the Medicaid landscape, including managed care principles, state and federal regulations, and the needs of vulnerable populations. The SVP of Medicaid will lead a high-performing team to deliver innovative, high-quality, and cost-effective healthcare solutions to Medicaid members, while maintaining strong relationships with state partners, providers, and community stakeholders.
ESSENTIAL RESPONSIBILITIES
Strategic Leadership: Develop and execute a comprehensive strategic plan for the Medicaid business, aligning with Highmark's overall mission and growth objectives. Identify and capitalize on market opportunities, address competitive threats, and drive innovation in Medicaid service delivery.
Clinical and Quality: Through matrix partners, leads the strategic identification, development and optimization of clinical programs while fostering key community relationships and partnerships, ensuring alignment with Medicaid's quality strategies and driving improved business performance and member clinical outcomes.
Financial Performance: Oversee the financial performance of the Medicaid line of business, including enrollment, growth, revenue management, cost control, and profitability. Develop and monitor key performance indicators (KPIs) to track progress against financial targets and identify areas for improvement.
Operational Excellence: Ensure efficient and effective operations across all aspects of the Medicaid business, including member enrollment, claims processing, care management, and quality improvement. Implement best practices to streamline processes, reduce administrative costs, and enhance the member experience.
Provider Network Management: Develop and maintain a high-quality provider network that meets the needs of Medicaid members. Negotiate contracts with hospitals, physicians, and other healthcare providers to ensure competitive rates and access to care. Foster strong relationships with provider partners to improve collaboration and care coordination.
State and Regulatory Relations: Serve as the primary point of contact for federal & state Medicaid agencies and other regulatory bodies. Develop and maintain strong relationships with key government officials, advocate for Highmark's interests, and ensure compliance with all applicable laws and regulations.
Medicaid Industry Leadership: Represent Highmark in relevant Medicaid industry trade groups and associations. Monitor and shape legislative and regulatory developments, participate in policy discussions, and contribute to the advancement of Medicaid best practices.
Team Leadership and Development: Build and lead a high-performing team of Medicaid professionals. Foster a culture of collaboration, innovation, and accountability. Provide coaching, mentoring, and development opportunities to support employee growth and advancement.
Community Engagement: Develop and implement community engagement initiatives to address the social determinants of health and improve the well-being of Medicaid members. Partner with community-based organizations to provide access to resources and support services.
QUALIFICAITONS:
Required
Bachelor’s degree in Business Administration/Management, Healthcare/insurance related field.
Minimum of 10 years of progressive leadership experience in the Medicaid industry or related government business
7 years in health insurance leadership
5 years of effective P&L Management or related financial management
Preferred
Master's degree in Healthcare Administration, Business Administration, or a related field.
Previous experience securing, retaining, and operating across multiple states and contracts
SKILLS
Deep understanding of Medicaid managed care principles, state and federal regulations, and the healthcare needs of vulnerable populations.
Strong financial acumen, with the ability to analyze financial data, develop budgets, and manage costs effectively.
Excellent communication, interpersonal, and presentation skills, with the ability to build relationships and influence stakeholders at all levels.
Demonstrated ability to lead and motivate a high-performing team, foster a culture of collaboration and innovation, and drive results.
Commitment to Highmark's mission, values, and ethical standards
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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