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Director, Medi-Cal Regulatory Strategy and Contracts

Location: Burbank, CA Additional Locations:
Job Number: 888163 Date posted: 07/27/2020
Description:
Provides leadership, strategy, and direction setting to support the contracting function of the Medi-Cal line of business for the SCAL and NCAL Regions; co-leads or leads statewide strategic initiatives; and participates as a key member of the National Medicaid Community of Practice. Drives strategy and execution of SCAL, NCAL, and state-wide Medi-Cal Health Plan Administration's Plan Partners and the Department of Health Care Services (DHCS) contract management functions and processes. Leads the strategy, development, negotiation, and implementation of significant Medi-Cal Plan Partner/DHCS contracting initiatives, including improved review, approval, and signature process.

Essential Responsibilities:
  • Negotiates highly complex financially competitive and predictable contracts. This includes leading collaboration with Actuarial Services, Legal, and internal advisors when appropriate. Evaluates multiple contract scenarios and modeling to provide the best quality, price, and service while ensuring contract responsibilities are aligned with internal operational capabilities.
  • Coordinates multi-Regional Plan Partner contract negotiations and employs project management skills and resources to develop project plans, identify milestones, identify resource requirements and manage the project. As part of contract negotiations, determines quality standards to be included in contracts, develops appropriate metrics, and plans for ensuring quality standards are met over the life of the contract.
  • Prepares a contract management profile for each Medi-Cal Plan Partner that includes financial performance metrics, rates, amendments, carve-outs, etc.
  • Ensures the submittal of information (e.g., monthly reports, encounters, financial, etc.), pursuant to contract terms, to Plan Partners, DHCS and other regulatory parties are completed timely with the most accurate and complete information available to Kaiser Permanente.
  • Services Regional and California Statewide stakeholders responsible for communications, assessments, identifying network needs, strategy development, financial, implementation, forecasting, etc. Develops strategy and leads overall responsibilities for establishing and managing stakeholder relationships.
  • Serves as the primary liaison between Kaiser Permanente CA Medi-Cal Programs and Plan Partners to support financial reporting and data analysis related to existing contracts, amendments, and/or ongoing contract negotiations.
  • As necessary, identifies qualified vendors to augment Kaiser Permanente's network of non-medical services for targeted member populations. When a vendor is engaged, leads the development of associated contracts, vendor management, and oversight to ensure Kaiser Permanente's quality and resource standards are met or exceeded by our community partners.
  • Oversees the development, negotiation, implementation, tracking and analysis of Medi-Cal Plan Partner and DHCS contract improvement initiatives and related metrics for assessing contract performance.
  • Leads and coordinates relevant health plan, hospital, and medical group personnel to support contract strategy negotiation, implementation, and performance improvement metrics.
  • Builds a focused, coordinated effort to build and promote Kaiser Permanente's brand and reputation through collaboration with National, California, SCPMG, TPMG, local Medical Centers and other KP departments.
  • Works closely with the VP, California Medi-Cal, and executive leadership to develop quality improvement and cost savings initiatives to ensure cross-functional integration and coordination of efforts.
  • Conducts region-specific budget preparation and policy and program implementation of federal and state initiatives.
  • Makes health plan adjustments to guarantee that Medi-Cal contracts are performing at or exceeding set targets.
  • Works closely with the California Medi-Cal leaders to ensure that health plan operations and care delivery programs for California are intimately aligned with Medi-Cal administrative health plan functions, including but not limited to DHCS All Plan Letter implementation, compliance, audits, and contract administration.
  • Establishes strategy to meet federal and state regulatory contracting requirements in partnership with key stakeholders such as National and Regional Provider Contracting, Medicaid, Medicare, Regional government programs, and Health Plan Regulatory Services.
  • Ensures detailed understanding of contract performance for the Medi-Cal business line, and building relationships with our communities to help differentiate KP and strengthen our reputation as a health plan.
  • Performs additional duties as assigned by the California Vice President of Medi-Cal, CHIP, and Charitable Care.
    Basic Qualifications:
    Experience
  • Minimum ten (10) years of relevant experience in a healthcare contract management related field, to include,
  • Minimum five (5) years of leadership and management experience in health plan, hospital and medical group administration, and government programs (e.g., Medicare, Medicade, or Medi-Cal experience).
  • Education
  • Bachelor's degree in business, finance, economics, health care administration, or other directly related field.
  • License, Certification, Registration
  • N/A.

  • Additional Requirements:
  • Demonstrated ability to sponsor line of business initiatives, and lead significant organizational change.
  • Significant experience working within the context of federal and state health care laws, regulations affecting physician and non-physician practice, facility operations, health plan administration, political process and legislative activity, contracting, financing and administration.
  • Demonstrated success in written and verbal communication, presentation, negotiation, public speaking, influence and collaboration.
  • Significant experience in developing and implementing strategic plans, with particular emphasis in Medi-Cal and State Programs.
  • Success in building and maintaining successful relations with external governments, agencies, clients and plan partners.
  • Deep knowledge of overall health plan functions, including operations, finance, public affairs, care delivery, member services, community benefit, claims, quality management and related regulatory services.
  • Strong business acumen with excellent strategic and analytical thinking capacity.
  • Demonstrated strong project management skills and implementation expertise.
  • Demonstrated success in developing strong, collaborative relationships with key leaders to achieve goals.
  • Drives work through strong leadership, influencing skills and strong healthcare knowledge.
  • Must be able to work in a Labor/Management Partnership environment.

  • Preferred Qualifications:
  • Twelve (12) years experience in contract management in Medi-Cal, Medicaid or Medicare contracts, with an in-depth business understanding of payment terms, carve-outs, exclusions, etc. between health plan and State or Federal Agencies. This includes the Two-Plan Model and COHS (County Organized Health Systems) structure in Medi-Cal.
  • Master's degree in business, finance, economics, health care administration, or other directly related field.
  •  
    Primary Location: California,Burbank,Marketing Sales Service and Admin 3100 Thornton Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Working Hours Start: 9:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Director/Senior Director Job Category: Sales and Marketing Department: CA Medi-Cal & State Sponsored Programs Travel: Yes, 20 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

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