Executive Leader Medicaid Business 101-8010
This role serves as the executive leader of the Medicaid line of business and will be responsible for the overall strategic direction, infrastructure development, operations, and management team, administering the plan in line with the organization’s mission and strategic imperatives. This role will be fully accountable for all organizational functions and will report directly to the President & CEO of CommunityCare with guidance from CommunityCare Executives and the Board of Directors.
- Spearhead the development, communication, and implementation of Medicaid growth strategies, particularly through contracting opportunities with provider groups and the potential expansion of health system sponsors.
- Establish Medicaid operational functions and develop strategic goals in conjunction with health system sponsors, CommunityCare Executive Team, and the Board of Directors.
- Executive oversight, in a matrix management setting, of all Medicaid business operations, including contracting, customer service, claims, compliance, finance, information technology, medical management, infrastructure, and network management; ensure that Medicaid operations are aligned with the health system sponsors’ overall strategy.
- Responsibility for operating the Medicaid line of business within budget, including expense management, and ensuring long-term financial success, sustainability, and growth.
- Ensure full compliance with federal and state laws and procurement requirements.
- Oversee the implementation, maturation, and expansion of the infrastructure necessary for the Medicaid line of business.
- of business development activities and accountability for establishing and carrying out responsibilities in coordination with other departments.
- Provide strategic insight about sponsor health systems and affiliated provider strategies.
- Supports recruitment of new participating sponsors and/or participating providers via network development, public relations, and communications.
- Support the development and execution of partnerships with cross-continuum capabilities (e.g., SNF, retail care, social determinants of health, tribal relations, community outreach, etc.).
- Oversee Medicaid staff and all associated functions, including recruitment, employee lease contracts, and human capital development.
- Lead the planning, development, and deployment of new business opportunities.
- Perform other duties as assigned.
- Demonstrated strong executive leadership within the healthcare industry.
- Adept at building relationships across a variety of personalities including community physicians, hospital leadership, the Board of Directors, and government officials.
- Strong analytical skills.
- Utilize excellent written, verbal, presentation, and communication skills.
- Ability to interact with key stakeholders to advance corporate objectives.
- Proficient in Microsoft Office applications.
- Successful completion of Health Care Sanctions background check.
- Bachelor’s Degree in Healthcare, Business Administration, or related field. Master’s Degree preferred.
- Minimum 10 years’ leadership experience in a managed care organization, or equivalent experience.
- Minimum 5 years’ Medicaid and/or Government Programs experience.
- Demonstrated success with project management, leadership, negotiations, and implementation of large-scale projects.
- Proven understanding of value-based contracting, IT systems and data analytics requirements, clinical quality programs, and FTC-sanctioned clinical integration.
- Robust financial acumen, budget creation, expense management, and strong problem solving and analytical abilities.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
- Pay Type Salary
- Tulsa, OK, USA