DescriptionJob Summary:The ED, Medicare Duals/SNP Programs will develop and execute the Duals and DSNP (Dual Special Needs Program) development plan across the Enterprise, as KP increasingly serves individuals who are eligible for both Medicare and Medicaid. This plan will include a single, enterprise approach to Duals governance, care coordination, social health, and product strategy for KP’s Dual eligible members. This leader will establish a dedicated Dual Eligibles Team that focuses on required and necessary Health Plan Administration, social needs, and care coordination responsibilities. Health plans are aggressively looking to grow in Duals and DSNPs where revenue streams from CMS (Centers for Medicare & Medicaid Services) are higher than those from Medicare alone.Comparatively, the commercial market has been relatively flat. Policy makers and regulators have increasingly focused on expenses and have pushed for better care coordination. This role is accountable for establishing and leading a multi-year, growth strategy for the Duals business across both the Medicare and Medicaid businesses. The selected individual will demonstrate experience in leadership, strategic planning and organizational, operational, and technical skills, and customer relationship management. This individual directs the efforts to demonstrate strategic leadership, produce high quality outcomes, growth and retention, financial performance, and operational execution to serve vulnerable populations. This role is expected to lead cross functional teams within the National Health Plan and partner with both Regional teams and Permanente Medical Groups to deliver on revenue, membership growth, operating income objectives, develop key care delivery relationships, establish an influential relationship with the State in partnership with Medicaid leadership, direct and effectively develop strategic goals into specific business plans, and create a successful, collaborative team to achieve these goals. This executive will manage a matrix organization of product, population health, model of care management, compliance, and regulatory teams to develop Duals products, enhancements, and ongoing management processes.Own strategic responsibility for Duals product, competitively positioning the product through an understanding of both the regional market and Federal and State regulatory landscape. Through these insights, produce a competitive product that aligns with regional objectives and delivery system for growth, quality, and margin. Analyze and recommend specific product strategies for Dually Eligible beneficiaries based on population and segmentation analysis to include Dual Special Needs Plans (DSNP), Chronic Special Needs Plans (CSNPs), Low Income Subsidy Plans (LIS), and Institutional Special Needs Plans (ISNP), where appropriate for the market, and that align around broader strategic, growth, quality, and margin objectives.This role will be accountable for ensuring an optimal CMS bid strategy while accounting for all State regulatory, policy, and operational parameters, inclusive of an intimate understanding of how CMS payment models and risk adjustment program parameters impact our strategic, financial, and operational approach.This role will partner with KP’s pharmacy organization to align formulary strategies and operational parameters with optimal product design and performance.Design the marketing and distribution channel strategies to grow from both external channels as well as optimize internal conversion strategies leveraging Duals specific strategies and partnership strategies (e.g., brokers, community partnerships, provider relationships, etc.).Design and execute a MOC that will deliver differentiated clinical, quality, affordability, and equity outcomes for Dually Eligible beneficiaries generally, and sub-segmented populations specifically - inclusive of national preparedness for Managed Long-Term Services and Supports (MLTSS) or other State initiatives in the pipeline for regional markets. This role will create and lead the Health Equity Index strategy to support optimal growth and quality alignment with CMS Health Equity Index parameters and optimize Star ratings, to include contract and PBP optimization, product design strategies, care coordination, and alignment with social health stakeholders, among others, to drive both penetration of Duals and top-tier performance as defined by CMS. This role will be accountable for understanding current and prospective State policies related to Duals, and the corresponding implications for product design, operating model alignment, regulatory compliance, and financial and operational coordination of benefits and payment policy execution. Through competitive intelligence, market research, and data driven analytics, identify opportunities for innovation in product design, network configuration, strategic partnerships, service improvements, and affordability opportunities.Serves as the Duals thought leader and policy expert within Government Programs, providing cross functional guidance to optimize performance of the product internally, and supporting advocacy efforts externally in partnership with government relations.This role works with Medicaid and Medicare teams, and other internal and external stakeholders, to ensure program requirements are met from RFP/ application through implementation. This role will participate in the development and review of all regulatory submissions, policy feedback, and other materials designated as relating to SNP products.This role will be responsible for ensuring all coordination of benefit, integration and data sharing requirements, and crossover claim policies are closely tracked and adhered to for both compliance and margin optimization.Ensure oversight and compliance of delegated entities for meeting the regulatory, quality, and margin expectations for the product.QualificationsBasic Qualifications:ExperienceMinimum eight (8) years leadership experience in health benefits marketing, sales, business development, account management, distribution channels, operations and administration, including at least five (5) years Government programs health plan experience in Duals, Medicare Advantage, and Medicaid experience.EducationBachelor’s degree in business administration, public health, or related field.Finance and/or actuarial experience preferred (as needed for bid development and strategy).Preferred Qualifications:Product design, P&L accountability for overall product performance preferred.Experience working with network and care delivery partnerships preferred. Master’s degree in business, public health, preferred.Job Field: Sales and MarketingJob Type: StandardSchedule: Full-timeJob Level: Director/Senior DirectorTravel: Yes, 20 % of the TimeEmployee Status: Regular Kaiser Permanente
