Louisiana Medicaid RVP Operations

Profile

Description

The Regional VP, Operations collects, analyzes and reports on various market data to connect financial outcomes with operational effectiveness. The Regional VP, Operations requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

Responsibilities

Humana's Louisiana Medicaid RVP, Operations (COO) will be responsible for the strategic development and oversight of operations for Humana's Louisiana Medicaid plan. 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 Leader will be based in Louisiana and will be directly accountable for operational results.

The RVP, Operations works with various groups such as Actuary, Corporate Finance, Risk Management, Quality, Network, Member & Provider Services, Clinical, Analytics and Sales internally, and Providers/Hospitals/Ancillary externally. Drives 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, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy.

Key Responsiblities


Liaise between the Louisiana Department of Health (LDH), plan leadership, and corporate contacts responsible for the execution of contract deliverables
Work with the plan CEO to maintain important stakeholder relationships throughout Louisiana
Lead internal infrastructure to review and improve operational functions
Manage implementation of strategic plans developed in cooperation with the plan CEO
Oversee development and maintenance of operational policies and procedures
Effectively implement business plans and oversee audit processes
Own execution of daily operating objectives and goals, including key performance metrics
Plan organizational growth and potential staff successions
Develop and cultivate a diverse and inclusive environment
Maintain intimate familiarity with contractual requirements and stipulations
Understand and actively manage ongoing adherence to local, state, and federal regulatory and programmatic requirements
Communicate with LDH and direct plan/corporate leadership regarding any necessary operational or regulatory changes
Lead conflict resolution for any provider relations or network issues that may occur
Implement and ensure compliance with corrective action plans if necessary


Required Qualifications


8 years of experience working in healthcare operations and/or health plan management
Bachelor's degree in Business, Operations Management, Healthcare Administration or related field
Leadership background with more than five (5) direct-reports
Louisiana Market Experience
Prior experience developing methods and criteria for measuring and summarizing data for complex analyses
Ability to lead and manage special projects that may necessitate cross-functional partnerships
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Experience in Medicaid MCO plan operational leadership; experience in strategic and thought leadership in supporting Medicaid health plans
Behavioral Health experience
Master's degree in Business, Healthcare, Public Health, or related field


Scheduled Weekly Hours

40

Company info

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