Executive Director, Medicaid - Shared Functions

Reporting to the National Senior Vice President of Medicaid, the Executive Director of Shared Functions is a key leader over the following areas: strategy execution, reporting and analytics, IT portfolio management, regulatory change management, provider validation and oversight, health care services solutions and health plan operations solutions. In addition, this leader will serve as a liaison with markets and Shared Services. This role will oversee end-to-end processes related to regulatory change management and validation of health plan provider compliance with Medicaid laws, regulations, sub-regulatory, and contractual guidance. Additional responsibilities include oversight of Medicaid reporting and analytics, health plan operations solutions and health care services solutions design and implementation. The position involves close coordination with a variety of KP regional, national, and shared service leaders and functions. The Executive Director of Medicaid Shared Functions maintains relationships and represents KP with a variety of external partners and stakeholders.

• Responsible for the strategy and execution of the provider validation and oversight function to ensure provider compliance with Medicaid laws.
• Responsible for the strategy and execution of regulatory change management end-to-end process and maintenance of state(s) requirements into KP-s operational structure. 
• Accountable for data analytics and regulatory reporting functions across all markets. Oversee regulatory reporting, data analytics and partner with others on the Medicaid solutions team to improve our ability to perform data exchange with 3rd parties, develop and manage risk stratification and cohort identification models, and align with our operational partners on internal reporting and dashboard needs as they arise.  
• Accountable for health care services solutions and health plan operations solutions, which design and implement new solutions to meet business, regulatory and operational requirements.
• Accountable for Population Health Management Initiative (PHMI), including implementation of a technology strategy as part of the PHMI program aimed to improve Community Health Centers- population health capabilities. 
• Work closely with all national, shared service and market leaders and other care delivery and medical group leaders to support Medicaid with implementation of the strategy, regulatory and operational requirements.
• Lead, manage, mentor, and develop Medicaid leaders and staff across the KP program to provide the subject matter expertise to support.
• Maintain a deep understanding of current and potential state and Federal Medicaid, CHIP and related legislation and regulations, and their impact on KP Medicaid strategy, operations, and performance.
• Monitor and maintain a deep understanding of the national and state health plan and provider competitive environment as it relates to Medicaid, dual eligibles and vulnerable populations.
• Establish, modify and monitor a comprehensive set of key performance metrics across all functions to monitor performance and compliance of the Medicaid line of business.
• Implement ongoing changes to Medicaid organizational structure, staffing and processes to improve effectiveness and efficiencies.
• Understand, plan, coordinate, and prioritize support from the regional health plan, national functional areas, and the national Medicaid team on initiatives and deliverables.
• Sponsor, lead, manage or participate in initiatives that are critical to our participation in Medicaid and may also impact our other business lines.