The SVP, Medicare reports to the SVP, Government Programs. He/she is responsible for ~$30B in revenue for the Medicare Line of Business (LOB). Specific duties include overall margin and quality performance for the LOB, including revenue and membership growth through national, regional, and local market sales strategy and execution, channel management strategies, model of care development and execution, and regulatory performance and compliance.
He/she will leverage industry best practices along with KP scale across the integrated delivery system to optimize overall performance of the Medicare Individual, Special Needs Plan, and Group segments. He/she executes through direct leadership and management, and through their collaboration with a wide range of other leaders, functions, and shared services throughout the KP health and delivery system. This requires tight partnership, alignment, and collaboration with the Regional Presidents and Executive Medical Directors to ensure the appropriate services, pricing, and care delivery value proposition exists to grow KP in each market.
The SVP works closely with KP-s senior leaders, including NHP, Care Delivery, PMG, and Program Office leaders to define short-term and long-term strategies and tactics that support KP-s ability to compete effectively in the Medicare market. Partnering with the Regional Presidents and Executive Medical Directors, the SVP continually assesses market opportunities/challenges and develops and implements business plans which address growth/market share, quality, and margin sustainability.
This includes direct influence over issues related to health plan NHP performance with respect to a wide variety of health care delivery and operational issues that affect performance, growth, regulatory compliance, and member experience. The SVP initiates, leads or supports selected major initiatives that enhance the competitive position, performance, and capabilities of the KP Medicare Line of Business. Essential
This position is responsible for ensuring short-term and long-term strategic direction and sustainable membership growth in KP-s Medicare LOB for all KP regions and segments through the leadership, collaboration and execution of market planning, regulatory management, channel strategy, sales and retention programs, model of care development and execution, and personnel. This includes: Overall accountability for ~$30B of revenue in the Medicare LOB.
Establishing/delivering on overall revenue, growth, and margin execution strategy for Medicare, identifying needs related to partnerships, resources, capabilities, and critical process changes to drive regulatory compliance, competitiveness, and scale. Collaborate with Regional Presidents and Executive Medical Directors to ensure that the -market-s voice- is clearly reflected in the national Medicare LOB growth plans.
Ensure short- and long-term growth through effective sales approach and competitive positioning of products, benefits, pricing, and KP brand for the LOB. Support the evolution of Kaiser Permanente-s value proposition within these lines of business through the development and implementation of Program wide marketing and operational plans. Lead competitive, legislative, and regulatory assessment and market scanning efforts to identify and forecast competitive trends in the marketplace in support of rate setting.
Develop advocacy plans that support KP-s unique value-based care model, competitive position, and long-term sustainability. Provide focused analysis of business strategies, financial performance, sales and marketing capabilities of health plan, hospital, and medical group competitors relative to the line of business. Ensure rate-setting decisions that successfully balance revenue requirements and market competitiveness through high quality, analytically supported decision-making process.
In partnership with SVP of Pricing and SVP, Marketing, develop strategic recommendations for all market segments. Medicare operational readiness (ready to sell, enroll and renew annually for AEP) and effective executive of AEP. Work effectively with clinical and care delivery partners to identify care model needs based on current and prospective member prevalence and acuity, and develop products, programs and services that will preserve KP-s differentiating advantage, quality, and affordability.
Direct and support market efforts to drive value-based networks and efficient, high-quality performance leveraging internal and external care delivery assets. Accountable for delivering on KP-s 5-Star quality performance. Direct and indirect leadership of Medicare employees and shared services organization team members, including resources within Program Office as well as in the regions who are dedicated to Medicare sales and membership growth activities.
Management of large, complex, strategic initiatives as well as design, development, and implementation of growth, transformation, and process improvement programs across the Medicare LOB. Provide strategic direction and coordination for Medicare offerings across the Program, incorporating regulatory, legislative, financing, competitive, and delivery system issues. Influence and participate in the development of KP-s Medicare policy based on the market and competitive issues KP faces across the Program.
Create the processes and activities necessary to ensure the development and focus on the regional level informs, and is consistent with, the Program wide effort. Ensure successful implementation of effective measurement systems and operating model to allow ongoing management of all business lines activities through monthly assessments of growth and margin performance. Qualifications
Experience Minimum ten (10) years experience in P&L and/or LOB ownership, inclusive of a combination of health benefits marketing, sales, business development, account management, distribution channels, clinical operations and administration, regulatory compliance, including five (5) years of senior management experience. Education Bachelors degree in related field OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required. License, Certification, Registration N/A Additional
Strong knowledge of all Medicare market segments, federal regulations, and compliance guidelines. Success in leading a high performing health plan functions in a multi-regional organization with multiple lines of business. Demonstrated success in managing complex organizational initiatives involving multiple functions and multiple business units/regions.
Includes the identification and articulation of problems, as well as the successful buy-in, execution and benefit realization. Successful leadership and management experience in large, complex organizations with multiple business units. The ability to build collaborative relationships and effectively communicate and influence a variety of senior business leaders, including physicians.
Understanding of current health benefits market forces and their implications for Health Plans, care delivery systems and KP.
Experience within large health care delivery organizations including integrated systems, is preferred. Master-s degree in business administration, public health, administration, or related field, preferred. Scheduled Weekly Hours: 40
Day Workdays: Mon-Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job
Full-time Job Type: Standard Employee Status: Regular Worker Location: Remote Employee Group/Union Affiliation: NUE Executives|NUE|Non Union Employee Job Level: Executive/VP Department: Po/Ho Corp - HP PROD-OFFC of SR VP HP OPS - 7016
$522000 - $652500 / year Travel: Yes, 20 % of the Time