Provides policy direction and coordinates efforts of pertinent operating units in matters involving state and federal governments. Ensures the provision of service to the proper administration of Medicare and Medicaid contracts, and maintains effective and cooperative working relationships with federal and state officials. Keeps current on local, regional and national affairs, policies, and legislation affecting health care and specifically, the managed care plan. Advises, develops, coordinates and directs internal policies as they relate to external affairs. Organizes, directs and ensures the compliance of all plan managed care programs with multiple State and Regulatory bodies. Assignments are broad in nature, usually requiring considerable creativity, originality and ingenuity.
- Oversees and manages policy development.
- Researches, monitors, and analyzes federal and state legislation and planning activities related to government funded initiatives and CMS regulatory changes.
- Reviews and monitors proposed and enacted Federal legislation impacting the managed care industry and develops business plans accordingly.
- Identifies, analyzes and makes recommendation regarding key legislative issues.
- Manages and directs the activity of federal and state government affairs.
- Works closely with CMS, state legislative leaders and any other government leaders to build coalitions to effect change that will have a positive impact on the managed care market.
- Assists and leads, where appropriate, with issues involving state and federal government relationships, including dealing with regulators to establish and continue effective working relationships.
- Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors.
- Plans, conducts and directs work on complex projects/programs necessitating the origination and application of new and unique approaches.
- Sets operational priorities and manages resources to operational goals and budgets.
- Develops strategies and ensures maximum efficiencies in the utilization of human and financial resources.
- With approval of Senior VP or VP establishes budget and monitors for adherence.
- Ensures corporate initiatives are implemented to achieve optimum results.
- Advises management in long-range planning for areas of specialization.
- Provides technical direction to functional managers, other directors and management.
- Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace.
- Recommends changes in area(s) policy and procedure.
- Performs other duties as assigned.
This position is contingent upon the bid award in the state of New Mexico to WellCare Health Plans, Inc.Candidate Education:
- A Bachelor's Degree in a related field or Business Administration required.
- A Master's Degree in a related field or Public Policy, Public Health, Political Science, Health Administration preferred.
- 10 years of experience in planning, development, health policy, legislative affairs, health care consulting or managed health care, and a proven track record of leadership experience in the health care industry required.
- 5 years of management experience required.
- In-depth knowledge of government programs and the managed care industry and proven experience leading and managing government programs through teamwork, collaboration and open communication required.
- Extensive experience working with key government groups, and the ability to identify and build relationships with key leaders within government health agencies and senior staff on committees that effect healthcare legislation required.
- Intermediate - Demonstrated leadership skills
- Intermediate - Ability to lead/manage others
- Intermediate - Demonstrated ability to deal with confidential information
- Intermediate - Demonstrated written communication skills
- Intermediate - Demonstrated interpersonal/verbal communication skills
- Intermediate proficiency in Microsoft Outlook, Word, and Excel required.
- Intermediate knowledge of and/or ability to utilize budgetary decision software applications.