Medicaid Regional President

Evolent Health is searching for a Medicaid Market President that can be the key market facing leader within a new Evolent market. This Market President will be responsible for overall operations of the health plan in support of our health system partners and to achieve the overall goals of the state Medicaid program and our business goals. This individual will be responsible for Network Development, Provider Relations, Member and Community Outreach, Government Relations, Compliance, Regulatory Affairs, Clinical Program outcomes, Medical Economics and overall financial success.
Reporting Relationship:
The Market President will report to the National Medicaid President.
Principal Accountabilities
In partnership with our client, lead the day-to-day activities of a statewide Medicaid health plan.
Provide executive leadership and management across a broad spectrum of responsibilities ? from strategy setting to operational execution.
Accountable for managing and achieving overall Profit & Loss for the health plan as well as other key financial outcomes such as Medical Loss Ratio and EBITA.
Directs and manages the organization's financial performance. Takes appropriate actions to increase revenue, leverage resources, manage andor minimize expenses
Serves as Evolent?s representative in the market for Board of Director meetings and executive committees.
Managing clinical team, prioritize programs and balance clinical outcomes and Utilization Management with the need to meet MLR or cost based initiatives for the organization.
Provide outstanding client service to our partners including the ability to adjust the style as necessary to meet client and business objectives.
Assist Health System Executives in collaborative efforts related to the development, communication, and implementation of operational business strategies and processes.
Foster effective, positive relationships with key external customers and brokers.
Ensure that the annual medical plan and end-to-end business processes are designed and working properly across functional boundaries.
Set clear goals and objectives using metrics to measure performance while holding staff accountable. Provide coaching to improve performance and hold regular development discussions with direct reports. Provide assistance in preparation and review of budgets and reports for assigned areas.
Assists and leads where appropriate, with aspects of state and federal government relationships, including working with regulators, as necessary, to establish and continue effective working relationships. Ensures that all state and federal regulations are met.
Oversees the development and maintenance of a viable provider network to ensure the health care needs of members are met. Develops or manages provider contracts and partnerships to achieve quality and cost management objectives. Works closely with providers to enhance relationships and maximize their ability to effectively manage the cost of medical delivery.
Coordinate with local hospital administrators, key physician leaders, client partners and the Network Contracting lead to promote the success of Evolent Health through its contracting, cost containment and quality initiatives.
Develop strategic plans and provider relationships that will promote physician collaboration with Evolent Health?s clinical programs.
Ensure strict compliance with federal and state regulations and company policies, procedures and processes.
Qualifications:
A bachelor?s degree in business or related field is required.
B.A. or equivalent graduate degree is preferred.
Ten-plus years of progressive leadership and management experience.
Ideal candidate will have served as Medicaid State President, COO or CFO.
Experience with managed care, payee and provider networks, and government relationships.
Demonstrated experience managing P&L and achieving key financial targets.
A strategic thinker and tactical executor who is able to move an idea from concept to reality.
A driver who is able to achieve organizational objectives and facilitate process improvement.
An accomplished executive with superior management skills and a successful track record of leading, developing, and mentoring leaders and future leaders.
Expertise in self-funded and fully-insured products.
Proven ability to interact with and influence clients at all levels.
Intense intellectual curiosity and an ability to view old problems with a fresh perspective.
Ability to attract, manage and develop staff of superlative quality
Excellent written, computer, and oral communication skills.
There are significant growth opportunities beyond local market management in this growing organization, as well, and strong performance in this role could lead to continued growth into responsibility over multiple markets. 73e785c8f8024322a63a7bd50d6afb45

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