Regional VP Operations - Florida Medicaid

Profile

Description

Humana is a Fortune 40 market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana starts from within, and is committed to providing progressive benefits that advance the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Humana's Florida Medicaid RVP, Operations (COO) will be responsible for the strategic development and oversight of operations for Humana's Florida Medicaid and Long-Term Care plan and will be directly accountable for operational results in those areas. This role requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise wide. He/she will manage ongoing operations across multiple levels of the organization to meet operational contract requirements and financial performance goals.

The RVP, Operations works with various groups such as Risk Management, Quality, Network, Member & Provider Services, Clinical, Analytics and Sales internally, and Providers/Hospitals/Ancillary externally. This person will be expected to drive optimization thru strategic planning and addressing specific business performance issues across matrixed organization and fostering key relationships with business stakeholders. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes.

The RVP will report directly to our Florida Regional President and will lead a team of 15 associates with four direct reports. This position will be based in Tampa, Florida and will require relocation for candidates currently located elsewhere.

Responsibilities

Key Responsibilities

Designs, coordinates, and completes operational improvement projects across various functional areas within Humana to improve services, manage ongoing adherence to local, state, and federal regulatory and programmatic requirements

Manages daily operational of multiple levels of staff and multiple functions/departments across Humana to review and improve operational functions to ensure the execution of daily operating objectives and goals, including key performance metrics

Collaborates with the plan CEO and Executive Team on strategy and business planning to achieve business goals and maximize financial and customer performance.

Leads Operations, plus matrix responsibility for other functional teams including but not limited to Billing and enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider Call Center, Provider Data Operations, and IT

Supports the development and execution of strategies to maximize growth, member retention, innovation, and member/provider experience for all products (Medicaid and LTC)

Owns business analysis and successful implementation of new contractual requirements

Partners with Contract Manager and Compliance Officer to manage process for timely and accurate regulatory reporting (non-financial) and updates to the Agency for Health Care Administration (AHCA)

Identifies and implements performance opportunities including those to improvement Member experience and Provider experience, efficiency, and accuracy

Informs and advises management regarding State current trends, and problems and activities to facilitate both short and long-range strategic plans to improve operational performance and enhance growth

Provides strategic leadership of provider network strategy to drive growth and performance, including oversight of Value Based Provider programs and MSO relationships

Delivers value to members by optimizing the member experience and maximizing new member growth and retention

Embeds health equity in all strategies involving member, provider and community

Leads change and innovation by demonstrating emotional resilience managing change by proactively communicating the case for change and promoting a culture that thrives on change

Develops and cultivates a diverse and inclusive environment

Builds, leads, and develops a team of 15 associates: coach and mentor associates with a goal of developing and retaining talent.

Key Candidate Qualifications

The successful candidate will have extensive experience (typically 8 years) working in healthcare operations and/or health plan management, including several years working in a matrix environment. He/she will have deep technical and financial understanding of health plan operations, particularly Medicaid. This person will be a strong leader of teams of at least 5 direct reports, with proven success in expanding and elevating the capabilities and performance of the team. Finally, he/she will have at least a Bachelor's degree in Business, Operations Management, Healthcare Administration, or a related field.

In addition to the above, the following professional qualifications and personal attributes are also sought:

Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Long Term Care or State health are programs for the uninsured)

Working knowledge of relevant federal and state regulations and requirements pertaining to Medicaid and Long-Term Care

Advanced analytical and problem-solving skills

Ability to lead and manage special projects that may necessitate cross-functional partnerships

Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences

Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome

Master's degree in Business, Healthcare, Public Health, or related field would be ideal

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com