The primary accountability of this position is to provide the operational leadership required to achieve the quality and financial performance goals for the designated geographic area. The Executive Director works to develop relationships with the markets’ various distribution channels in order to manage to sales targets in plan. The Executive Director has the P&L level responsibility for the product and the direct management responsibility for network design and compliance, contracting with product-wide medical and administrative services, quality management and compliance, quality improvement, financial and performance reporting and network relations. Of highest importance, the Executive Director must maintain strong IPA performance and compliance such that strategic goals are routinely achieved.
Develop and maintain strategic and annual business plans that can achieve agreed to quality and financial performance objectives.
Develop and maintain key medical and administrative contracts needed to achieve objectives. Negotiate and maintain product-wide medical provider contracts with financial and other terms that are at least as competitive as those of similar organizations.
Provide the appropriate level of oversight to ensure compliance with all CMS and applicable state insurance department regulations governing the health plan products.
Achieve and maintain strong business relations with providers of contracted administrative services, medical care providers and organizations, sales distribution channel, and other key customer groups.
Design and execute revenue and member growth strategies.
Maintain a highly effective quality compliance program covering all areas required to meet internal organizational objectives and to achieve compliance with HEDIS, NCQA, CMS and other regulatory requirements.
Achieve significant competitive advantage by recruiting, developing and supporting outstanding administrative and medical staff for the health plan organization.
Other duties and/or responsibilities as assigned by management.
Sarbanes-Oxley Act requirements:
Has direct responsibility for compliance with the Sarbanes-Oxley Act in matters of financial and operational controls, and disclosure requirements as mandated by the act.
This includes strict adherence to the company’s Business Conduct Statement and Code of Ethics. The emphasis will be on compliance with financial procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
Minimum five years experience in managing health plans, IPAs, or other directly related managed care organizations.
Minimum five years experience in successfully meeting CMS, and applicable state insurance department regulatory requirements.
A clear track record of executive leadership in growing an organization, achieving quality and financial performance objectives, designing and implementing strategic initiatives and building outstanding working relationships with physicians.
Masters degree in business administration, health care administration, finance or other related area is preferred.
Key personal attributes include: strong desire to lead and be at-risk for performance, ability to inspire others to achieve outstanding results, willingness to set priorities and maintain strategic focus, maintain the highest standards of integrity and business ethics and a passion for personal and team success.
Bachelors Degree required; Masters Degree preferred
Medium to extensive travel
State or Province