VP-Medicaid

Overview

Location Address: 9521 San Mateo NE, Albuquerque, New Mexico , United States of America

Summary: Presbyterian Health Plan (PHP) seeks to remain a national leader in serving the complex and diverse needs of Medicaid members and in working with State and Federal agencies to design and implement new and innovative programs and services to meet the unique needs of this population. The position reports to the President of PHP and is accountable for all aspects of our Medicaid program, including serving as the sole Contractor for Children in State Custody.

The role provides strategic and thought leadership on a national scale, connected to the needs of New Mexicans across diverse communities, including rural, frontier, Native American sovereign ties, and urban centers. The Medicaid program covers physical, behavioral health, and long-term services and supports (LTSS) for Medicaid members, including dental, vision, pharmacy, and the full spectrum of social determinants of health to support health equity.

The position offers an opportunity to lead Medicaid programs that impact vulnerable populations. The ideal candidate will combine strategic vision, operational expertise, leadership, and government relations experience to advance Presbyterian’s mission of ensuring all members achieve their best health.

• Developing and executing strategic plans that meet the needs and expectations of Medicaid members, relevant State of New Mexico agencies including the Healthcare Authority (HCA) and Children, Youth and Families Department (CYFD), CMS, and key stakeholders.
• Forming, collaborating with, and leading diverse teams across PHP to ensure effective delivery of Medicaid services while maintaining regulatory compliance and achieving organizational strategies, goals, and metrics, as well as those of HCA and CYFD.
• Providing ongoing surveillance of national and state market changes to ensure PHP remains competitive and viable. Leading the design, development, and enhancement of Medicaid programs to meet evolving beneficiary needs, including models applicable to Children in State Custody and Behavioral Health.
• Providing thought leadership and input on the State’s strategy to align Presbyterian’s capabilities and new business models, including improving access to behavioral health and substance use disorder services and expanding services for Children in State Custody.
• Overseeing day-to-day operations for Medicaid programs in collaboration with executive and operational leaders. Leading functional teams to serve Medicaid members and meet stakeholder needs, including network contracting and development, claims, population health including pharmacy, etc.
• Aligning Medicaid to Dual Special Needs Plan (D-SNP) requirements to support optimal performance and outcomes.
• Monitoring changes in Medicaid waivers, state plan amendments, policy, and legislation to mitigate risks, inform strategies, and maintain program integrity. Engaging in government relations to positively shape PHP’s Medicaid program perception.
• Providing strategic direction over quality initiatives to improve the quality, efficiency, and effectiveness of Medicaid services, including performance measures, outcome evaluation, and continuous process improvement.
• Establishing and overseeing strategic work streams and deliverables, scorecard metrics including quality, experience, and financial measures, to maximize value for members and stakeholders.
• Building and maintaining relationships with government agencies, healthcare providers, advocacy groups, community organizations, and policymakers.
• Developing and leading high-performing teams, fostering accountability, innovation, and excellence.
• Leading all Medicaid procurement activities, including market and technology assessments, resource planning, market positioning, consultant sourcing, marketing and branding, and the response development cycle.

• Bachelor’s degree in healthcare administration, public health, business administration, or related field.
• Extensive experience (10+ years) in healthcare management with a focus on Medicaid programs.
• In-depth knowledge of Medicaid programs,…