Department: Health Services
Reports to: VP Medicaid Product and Regulatory Affairs
Location: 3031 North Rocky Point Drive, Tampa, FL 33607Determines and drives the policies, operational planning, and execution of performance for the Children Medical Services (CMS) Health Plan and the State's Children with Special Healthcare Needs Product. This includes but is not limited to; product development and strategy, evaluating market performance and industry trends, and providing both strategic and tactical direction across all clinical, operational services. Develops and maintains relationships across the State with key stakeholders that are critical to the performance of the CMS program, such as the Department of Health (DOH), successfully developing strategies and managing the complexities associated with ensuring the market's Medicaid deliverables due to AHCA are properly coordinated with the DOH.
Additional Responsibilities: Candidate Education:
- Develops, drives and executes the strategy for all aspects of the CMS Health Plan and Children with Special Healthcare Needs Product portfolio.
- Liaises across multiple key internal functional areas to drive decisions and initiatives critical to the success of the plan.
- Represents the Company externally as the executive leader for the CMS Health Plan, including fostering strong working relationships with key State Agency officials, community organizations, advocacy groups, and other key stakeholders.
- Develops strategies to effectively manage the complexities associated with serving the DOH in the capacity of a “vendor” for the CMS Health Plan and ensures Medicaid Market deliverables due to AHCA are properly coordinated with the DOH.
- Oversees and directs the operational aspects of the CMS Health Plan, including care and utilization management, network and provider relations, quality improvement, health IT, and overall administration including legal and finance. Coordinates with key internal stakeholders to ensure processes and timelines are established for routing Market Medicaid deliverables due to AHCA through appropriate DOH review processes.
- As a result of effective partnerships, shares responsibility for Quality Improvement & accreditation initiatives for the CMS Health Plan.
- Partners with the Network team and providers focused on children with special healthcare needs to design and implement strategies aimed to improve and evolve the delivery system for the CMS Health Plan, including working collaboratively with providers to encourage development of value-based payment models.
- Ensures compliance requirements and DOH and State reporting related to the plan are achieved in accordance with service level agreements; creating and driving appropriate sense of urgency with key stakeholder to meet accelerated deadlines as appropriate.
- Performs other duties as assigned.
- Required A Bachelor's Degree in a related field or equivalent experience
- Preferred A Master's Degree in a related field
- Required 10 years of experience in Health insurance industry
- Required 5 years of experience in Product management / development roles
- Required 7 years of experience in Managing or leading teams
Licenses and Certifications:
- Advanced Ability to communicate and make recommendations to upper management
- Advanced Ability to effectively present information and respond to questions from families, members, and providers
- Advanced Ability to represent the company with external constituents
- Advanced Demonstrated interpersonal/verbal communication skills
- Advanced Demonstrated leadership skills
- Advanced Demonstrated organizational skills
- Advanced Demonstrated written communication skills
- Intermediate Knowledge of healthcare delivery
- Advanced Other Have a clear understanding of the managed care field and managed care operating components, with emphasis on clinical management of behavioral health services, particularly within an integrated managed care model.
A license in one of the following is required:
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft PowerPoint
- Required Intermediate Microsoft Excel
- Required Intermediate Healthcare Management Systems (Generic)