VP, General Manager Government Programs - PNW Markets

Kaiser Permanente

Renton, WA

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JOB DETAILS

SKILLS

Actuarial Skills, Advertising, Alliance/Partner Management, Analysis Skills, Brand Marketing (Branding), Budget Management, Business Administration, Business Development, Business Growth, Candidate Screening, Capacity and Performance Management, Centers for Medicare and Medicaid Services (CMS), Channel Management, Clinical Data, Clinical Outcomes, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Content Management Systems (CMS), Cost Control, Customer Experience, Data Analysis, Disease Prevention and Control, Distribution Channel, Drug Development, Economics, Federal Laws and Regulations, Finance, Financial Management, Financial Planning, Forecasting, Government, Health Plan, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Management, Healthcare Providers, Healthcare Quality, Improvement Metrics, Interpersonal Skills, Lead Generation, Leadership, Market Share, Marketing, Marketing Campaign, Marketing Communications, Marketing Strategy, Medicaid, Medicare, National Sales, Network Integration, Network Performance/Analysis, Network Programming, Operational Improvement, Operational Strategy, Operational Support, Operations Management, Operations Planning, Performance Management, Performance Metrics, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Product Development, Product Positioning, Profit & Loss, Public/Media/Press/Analyst Relations, Quality Management, Quality Metrics, Regulations, Regulatory Compliance, Risk, Risk Management, Sales Strategy, Sales Support, State Laws and Regulations, Strategic Planning, System Integration (SI), Team Player, Writing Skills

LOCATION

Renton, WA

POSTED

25 days ago

Job Summary: The Vice President and General Manager, Government Programs is a senior leadership role accountable for driving sustainable growth across the Medicare Advantage (MA) business line. This role is responsible for overseeing the strategic direction, growth, quality, clinical outcomes, network development, and financial performance of the Medicare Advantage line of business in designated local or regional market(s). This role requires a leader with expertise in Medicare Advantage, network development, and integrated delivery systems. Success in this role requires strong collaboration and partnership with key internal and external stakeholders (including providers and government regulators) to drive operational excellence, member satisfaction, and financial success. Essential Responsibilities: + Strategic Regional Market Leadership for the MA Line of Business: + As an integrated member of the regional market leadership team(s), develop and implement competitive, market-specific strategies to enhance financially sustainable Medicare Advantage growth and market share, achieve Kaiser Permanente (KP) target economics, and create alignment with the KP integrated care and coverage model to drive a differentiated value proposition around affordability and quality for CMS and members. + Lead the positioning of KP by leveraging high-level collaboration and influencing skills to drive exceptional performance within a large, complex, multi-regional enterprise. + Collaborate with regional market leadership, PMG, care delivery, National Health Plan (NHP) functional leaders, and other KP system stakeholders (e.g., Foundation, Federation, Medicare executive sponsors) to align market operations and performance with the organizations mission, vision, and sustainable, value-based care strategies. + Ensure all market specific strategies align with the overall balanced portfolio of the regional market economic targets and strategic growth objectives. + Financial Performance: + Manage the regional market P&L for the MA line of business, ensuring target economics are achieved through revenue optimization and effective cost management. + Develop and monitor budgets, forecasts, and financial plans to support strategic and operational initiatives, and lead regional MA performance management through a defined operating model. + Collaborate with actuarial, national Medicare finance (NMF), risk adjustment, and program office teams to align membership forecasting with strategic market objectives, ensure the accuracy and completeness of risk adjusted revenue, drive identification, execution, and regular monitoring of medical cost initiatives, recommend network strategies to optimize value-based care, and ensure administrative efficiency. + Growth and Business Development: + Identify and pursue opportunities for sustainable membership growth through product development, effective distribution channel management, and strategic partnerships within the KP integrated care and coverage model and through other external, value-based providers. + Develop and execute market strategies to position KP for sustainable growth in Medicare Advantage by partnering with senior leaders in National Medicare Sales. + Strengthen brand identity and member preference to maximize marketplace value and long term member tenure. + Collaborate with National Marketing to develop and execute marketing strategies for growth in existing and new markets including marketing campaigns, advertising, marketing, marketing communications, brand, and public relations strategies that support MA strategic sales objectives and membership, revenue, and margin goals. + Leads initiatives to improve member retention, experience, and competitive positioning through differentiated senior care models. + Provide strategic guidance on product development, benefit design, and core competencies to ensure market competitiveness and alignment with customer needs. + Recommend MA specific member experience improvement opportunities and drives initiatives across the organization. + Quality and Clinical Outcomes: + Implement programs (and define the demand) to improve clinical quality metrics, including Star ratings (HEDIS, CAHPS, HOS), ensuring integrated care delivery aligns with members needs and organizational goals. + Partners with risk adjustment to align market specific prevalence and acuity data to clinical program development and network strategies. + Collaborate with clinical leadership to develop and execute care management, disease management, and population health programs tailored to Medicare Advantage members, including Dual Eligibles. + Network Development, Performance Management, and Provider Engagement: + Drive MA/Duals specific innovation in care models through partnerships with providers and/or value-based vendors to address senior oriented population health needs, improve affordability, and enhance quality outcomes. + Recommend and drive network strategy recommendations to meet the unique needs of Medicare Advantage membership in the KP regional market, inclusive of specific senior care, community aligned, value-based (and potentially risk bearing) providers. + Monitor internal and external network performance metrics, including access, utilization, cost of care, and member outcomes, to ensure high-quality, efficient care delivery. + Collaborate with clinical and operational teams to address network gaps from the perspective of CMS regulatory compliance, access, and availability standards, as well as performance against member experience and outcomes expectations. + Foster collaborative relationships with PMGs and external providers through transparent reporting and joint initiatives focused on shared goals and continuous quality improvement. + Operational Management: + Monitors operations of the Medicare Advantage business, ensuring achievement of both member experience expectations and compliance with all federal and state regulations. + Partners with NHP compliance and operations, surfacing potential risks through proactive management of leading indicators. + Partners with government programs operational leadership to recommend and track synergistic efficiency opportunities across processes and systems. + Regulatory Compliance: + Ensure all regional operations comply with CMS guidelines, state regulations, and internal policies. + Stay abreast of changes in Medicare (and Dual/Medicaid) regulations, as appropriate to the market and product portfolio, and adjust strategies accordingly. Basic Qualifications: Experience + Minimum ten (10) years of experience in healthcare management, with at least five (5) years in leadership roles overseeing Medicare Advantage operations and network development. Education + Bachelors degree in Business Administration, Healthcare Management, related field or equivalent experience or four (4) years of experience in a directly related field. + High School Diploma or General Education Development (GED) required. License, Certification, Registration + N/A Additional Requirements: + Deep understanding of the health care industry and dynamics. + Demonstrated expertise in MA health plans, integrated delivery systems, value-based care models, and provider engagement. + Strong knowledge of CMS regulations, Medicare Advantage operations, health plan financial management and clinical operations. + Proven track record of driving growth, improving network performance, and achieving financial and clinical quality excellence + Exceptional leadership, communication, and collaboration skills. + Proven success in analysis of complex data to drive informed strategic decisions in a matrixed environment. + Proven ability to influence a complex organization to ensure that performance standards are customer driven. + Exceptional leadership, interpersonal, communication (oral and written), and collaboration skills. Excellent creative and analytical problem-solving skills. + Ability to credibly influence decision makers to take action of fact-based recommendations. Preferred Qualifications: + Masters degree strongly preferred. COMPANY: KAISER TITLE: VP, General Manager Government Programs - PNW Markets LOCATION: Renton, Washington REQNUMBER: 1426024 External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

About the Company

Kaiser Permanente

At Kaiser Permanente, we are relentless in our pursuit of excellence. Driven by our mission to provide the highest quality preventive medicine, we are committed to eliminating health care disparities, and to making lives better through innovation, technology, and research. Our desire to deliver the best possible care inspires us to promote wellness among our members, communities, and each other. It also fuels our belief that everyone — regardless of circumstance — deserves access to affordable care, which further drives our motivation to expand our reach. Founded nearly 80 years ago, our unique business model sets us apart — positioning us to drive improvements across the industry and around the world.

COMPANY SIZE

10,000 employees or more

INDUSTRY

Other/Not Classified

FOUNDED

1945

WEBSITE

http://www.kp.org/careers