The position leads the Medicaid member market as the subject matter expert and strategic visionary of Behavioral Health clinical care management for Medicaid market members. Serves as the central point of contact to stakeholders for acquisition and retention of key contracts and business. Supports the organization’s ability to acquire, build and manage customer relationships on Medicaid products and services. Responsible for the oversight, maintenance and growth of business line, and is responsible for setting a business plan that informs the company’s go to market strategy for the Medicaid market utilizing defined and leading clinical care management products and services and working with service areas to understand market requirements and ability to deliver services. Liaison and key business partner between the Sales organization, Strategy, Shared Service Operations, Clinical Center of Operational Excellence, Clinical Centers of Excellence, and the Medical Director. Responsible for achieving business objectives and goals, helping to cultivate and foster relationships with current and new customers in the Medicaid market, and collaborating with other service areas of the organization to confirm effective delivery of defined services.
Sets and executes strategic vision and objectives for the Medicaid market using market analysis and industry trends.
Develops and implements long-term strategic initiatives focused on achieving operational excellence in the Medicaid market.
Collaborates with Behavioral Health Medical, Clinical and Shared Service Operations to effectively communicate capabilities, products, and solutions to new and potential Medicaid customers to ensure ability to administer services effectively.
Ensures contract requirements are understood, communicated, and met; deliverables are accurate and delivered in a timely manner; participate in rate setting discussions.
Designs, develops, and implements programs in Medicaid market focused on improving effectiveness, affordability, and quality of care.
Oversees performance of Engagement and Care Management teams in a Matrix reporting relationship alongside the Center of Operational Excellence Leads.
Assumes responsibility for growth, revenue, cost of care, operating gain, quality results and operational efficiency/effectiveness related to the Medicaid business.
Consults with clinical stakeholders to develop improved utilization of effective and appropriate services, including effective member engagement strategies.
Collaborates with Care Management Operations Lead, Engagement Operations Lead, Routine and Complex Care Management and Transition of Care Medicaid Managers to ensure operational goals are aligned to Medicaid’s strategic plan and vision.
Develops and implements action plans to improve performance and department outcomes, manage medical cost trends, and provide leadership periodic updates.
Provides leadership and expertise representing Medicaid in new business activities (RFP responses, new market and product development, etc.) and upsell and cross-sell opportunities with existing clients.
Collaborates on the development and implementation of a staff plan, including learning and development strategy, in collaboration with the relevant Magellan leaders.
Anticipates and acts on emerging healthcare trends to position the Medicaid line of business for the future, in conjunction with other Magellan leaders.
Other Job Requirements
5 or more years of experience in professional practice
7 years post-degree (masters/doctoral) experience in behavioral health
7 years working with Medicaid populations
Significant experience managing Medicaid clinical operations
10+ years of experience in healthcare with a clinical and/or operations management focus.
10+ years of management level experience in the managed healthcare industry required.
Knowledge of government and CMS policies regarding Medicaid eligibility, programs, and beneficiaries.
Knowledge of managed healthcare delivery systems to include critical components and interdependencies.
Knowledge of the variety of financial and clinical structures viable in the managed care arena.
Knowledge of clinical issues unique to the delivery of mental health and substance abuse services, of strategic planning
and the budget process.
Ability to communicate and advocate at the line through corporate staff levels.
Must possess strong analytical and organizational skills in a multiple site and function environment.
Proven ability to manage operations in a clinical healthcare system.
Strong negotiating and contracting skills.
General Job Information
VP, Market Leader – Medicaid, Behavioral Health
Behavioral Health, Clinical, Management/Leadership
Bachelors: Behavioral Health (Required), Doctorate: Psychology, Masters: Behavioral Health, Masters: Business Administration, MD, PhD
Clipped from: https://gr8usajobs.com/jobs/vice-president-market-leader-medicaid-behavioral-health-missouri-city-missouri/271365028-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic