Emergent Holdings Director Medicaid Contract Program Management

Clipped from: https://diversity.usnlx.com/philadelphia-pa/director-medicaid-contract-

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Emergent Holdings Philadelphia, Pennsylvania

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This position could be located in any major metropolitan areaResponsible for the strategic vision and operational expertise to successfully lead the EM Medicaid Program including the management of the AmeriHealth investments and Blue Cross Complete. Prepare and implement business plans and strategies to ensure profitable operations, meet short-term objectives, and support long-term growth and success. Manage and monitor all Medicaid contract provisions and conditions to ensure accurate and consistent administration, executive reporting, and performance to optimize business success and sustainability. This includes managing contracts that summarize the compilation operational parameters, service targets, work to reduce corporate liability, and minimize the risk of contractual breaches. *Responsible for accurate and consistent Medicaid contract performance analysis ensuring issues/opportunities are identified and appropriately presented to senior executives and the board for mitigation and adherence. *Responsible for optimizing business performance opportunities to ready the organization for the Medicaid bid cycle. *Responsible for the creation and issuance of monthly Medicaid scorecards and business material and the reporting at various business unit levels for internal senior executive leaders, as well as the EH Board of Directors and BCBSM. *Responsible for Medicaid business reporting of the demonstration of contract performance and offer suggestion of risk mitigation, identification of opportunity, escalation of operational issues, and monitoring of performance and adherence to contract provisions. *As a strategic partner of EH and BCBSM, responsible for conducting ongoing Medicaid program assessments and make recommendations for strategic initiatives, goals, and objectives. *Responsible for tracking multiple business/strategy/IT initiatives to assure desired outcomes and spending levels are being achieved. *Enables the creation and review of legal formation and legal agreement contractual documents (NDAs, SOWs, MSAs, Letters of Intent, etc.) *Proactively manage trends, analyze contract parameters, and forecast if operational goals are being met as outlined and expected in the contract. *Performs ad-hoc projects, research, and analysis in support of key stakeholders. *Provide oversight of compliance requirements as well as the development of protocols and monitoring programs that assess compliance of large-scale company contracts. *Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations. *Responsibility for balancing workload to optimize the effectiveness of the department. QUALIFICATIONS *Bachelor’s degree in Business Administration or Finance required (Master’s degree or Juris Doctorate preferred). Continuous learning is required. Certification or progress toward certification is highly preferred and encouraged. *Ten (10) years of experience in contract management, insurance business or relevant combination of education and experience may be considered in lieu of degree. *Seven (7) years of relevant experience which provide the necessary skills, knowledge, and abilities. *Five (5) years of prior management or supervisory experience. *Previous experience in the insurance industry experience preferred. *Experience working in healthcare, insurance, finance, compliance or legal. *Experience managing merger, acquisition, or divestiture transactions. *Experience working with and managing contracts and legal parameters. *In-depth experience in Medicaid regulations. *Knowledge and understanding of legal requirements involved in operating contracts. *Ability to analyze the operations of a business unit and identify the key performance drivers. *Analytical abilities to assemble various data components into a clear, concise picture of financial and operational performance. *Strong presentation skills, both developme

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