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Company: MedStar Medical Group
Location: Baltimore, MD
Career Level: Director
Industries: Not specified
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Description

General Summary of Position
The Vice President (VP) & Executive Director is the visionary leader responsible for the long-term success and sustainable growth for MedStar's health plan. The incumbent requires a passionate advocate for health equity, coupled with strategic expertise in navigating the complexities of the Medicaid program and leading the organization through dynamic regulatory and healthcare environments. The VP & Executive Director is accountable for the day-to-day operations and profit and loss accountability of MedStar Family Choice - Maryland. Responsible for integration of the strategic plan of the organization. Manages the operational and financial results of the health plan and provides executive direction and leadership to management and associates. The ideal candidate will champion the needs of our members while cultivating strong partnerships with state officials, providers, and community organizations.


Primary Duties and Responsibilities

  • Possess a deep understanding of the Medicaid program framework, including eligibility criteria, financing models, provider network management, and program regulations.
  • Develops department goals, objectives, policies, and procedures. Ensures compliance with business unit policies and procedures and governmental and accreditation regulations.
  • Oversee the financial health and sustainability of the Medicaid health plan. Manage budgets, revenue projections, resource allocation and ensure fiscal responsibility and compliance with regulations. Develops and recommends department operating budget and manages resources according to approved budget.
  • Selects, trains, orients, and assigns department staff. Develops standards of performance, evaluates performance, and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs, provide feedback, discuss new developments, and exchange information.
  • This position involves leading a management team of direct reports and shared services staff and managing within a matrix environment. This position is accountable for all aspects of plan operations, ensuring quality, cost-effectiveness, and a positive member experience.
  • Develops and contributes to the achievement of established goals and objectives and adheres to MedStar Health, MedStar Family Choice (MFC"), and MFC policies, procedures, quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.
  • Advocate for Medicaid program improvements and access to quality healthcare for underserved communities. Collaborate with government agencies, community stakeholders, and healthcare providers to enhance program effectiveness.
  • Analyzes and develops new business strategies to increase market share and to improve overall performance.
  • Provides guidance and assistance in contract negotiations and maintains relations with all providers.
  • Establishes formal and informal mechanisms to promote and maintain credibility, competence, and a positive global image by exhibiting strong communication to the corporate entity, providers, members, regulators, and community organizations.
  • Provides assistance and input to the medical expense economics team charged with analyzing cost drivers and identifying and implementing cost improvement plans where appropriate.
  • Ensure strict adherence to all federal and Maryland state Medicaid regulations, including data privacy and security measures. Proactively monitor legislative changes and adapt strategies accordingly. Provides leadership and maintains operations and procedures to ensure MedStar Family Choice is in compliance with its government contracts.
  • Assists in the development of annual and long-range operating and capital budgets and forecasts for MedStar Family Choice.
  • In collaboration with the President of MedStar Family Choice, develops, implements, and manages a strategic planning process that results in a vision for MedStar Family Choice consistent with MedStar Health's strategic plan, and defines the specific operational strategies required to accomplish those organizational goals and objectives.
  • Serve as the principle point of contact and liaison between MedStar Family Choice - Maryland and the Department of Health. In collaboration with the Chief Finance Officer, serve as a liaison with the Maryland Insurance Administration (MIA).
  • Ensure exceptional member experiences and satisfaction. Lead efforts to address member concerns, resolve issues promptly, and provide accessible support resources.
  • Responsible for representing or designating representative(s) for MedStar Family Choice-Maryland at all meetings called by Department of Health, MIA, and other agencies.
  • Prepares and presents information concerning MedStar Family Choice operational performance and strategies to the MedStar Family Choice board of directors.
  • Participates in meetings and on committees and represents the Maryland health plan in community outreach efforts.



    • Minimum Qualifications
    Education

    • Bachelor's degree in Business Administration, Public Health, Health Administration, or related field required
    • Master's degree preferred

    Experience

    • 10+ years Progressively responsible experience in healthcare, deliver systems, or health plan in a senior role, ideally with a managed care organization; successful experience with more than one organization is preferred. required
    • Minimum of five (5) years in a senior leadership role within a Medicaid organization. required

    Knowledge, Skills, and Abilities

    • Proficient problem solving, including being able to identify and resolve complex problems, such as developing innovative solutions based on extensive knowledge of managed care.
    • A broad understanding of information systems and programs and the strategic and operational values they bring to healthcare analytics and operations. Complete understanding of the financial, operational, and regulatory processes of the Maryland/District of Columbia Medicaid managed care program.
    • Excellent verbal and written communication skills.


    This position has a hiring range of $213,800 - $289,200



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