VP of Govt Programs
hace 1 semana
PriMed/Hill Physicians Medical Group has retained Morgan Consulting Resources to conduct a search for the Vice President of Government Programs and Full Risk Business . This is an outstanding opportunity to be an integral member of a dynamic and growing organization. This position can be based in San Ramon or Sacramento, CA with an opportunity for a hybrid work schedule of at least two days a week in the office.
About the Company: Hill Physicians was organized over 40 years ago and has become the largest Independent Physician Groups (IPA) in California with over 6,000 physicians working in over 3,200 offices throughout Northern California. Currently, Hill Physicians cares for approximately 300,000 HMO members through multiple health plans. In addition, in recent years, they have aggressively and successfully broadened their clinical outreach and now also provide care management services for approximately 120,000 attributed PPO patients. Collectively, Hill Physicians' doctors care for approximately 420,000 patients.
About the Position:
Reporting to the Chief Financial Officer (CFO), the Vice President, Government Programs and Full Risk Business will oversee the Government Programs operations and manage the Full Risk business with an annual operating revenue of over $150 million. The VP, Government Programs and Full Risk Business will develop and implement comprehensive strategies for the Government Programs department and the Full Risk Business Unit to meet evolving market demands and position the company for growth while ensuring compliance with all federal and state regulations.
We are looking for an experienced and strategic leader who will drive the growth and success of the Medicare Advantage, MediCal, ACA, and Full Risk lines of business. Hill Physicians launched their Medicare Advantage full risk business in 2020 and currently serves 14,000 members. Under the full risk arrangement, they assume Medicare Advantage full risk by accepting both institutional and professional risk-based capitation payments.
Select Responsibilities:
- Oversee the financial performance of the Medicare Advantage, MediCal, and Affordable Care Act (ACA) programs including risk adjustment/coding accuracy, provider incentive program, and vendor management.
- Oversee the full risk business unit P&L to ensure it meets its financial objectives. Develop financial reports and analyses to drive performance improvement, maximize revenue, and effectively manage budget and cost.
- Lead cross-functional teams in a matrixed organization, fostering collaboration among departments such as clinical management, utilization management, quality management, and financial analysis to achieve corporate goals.
- Build and maintain robust relationships with health plan executives, internal stakeholders, and external partners to enhance collaboration, data exchange, and performance improvement strategies.
- Define key performance indicators (KPIs) and develop monitoring systems to assess the effectiveness of programs and operations in real-time. Utilize data analytics to drive decision-making and proactively address performance issues.
- Direct the day-to-day operations of the Full Risk and Government Programs teams, ensuring all deliverables are met while coordinating necessary activities to support the organization's strategic goals.
- Ensure adherence to CMS regulations and DMHC requirements, working closely with legal and compliance teams to mitigate risks and ensure operational integrity.
Qualifications & Experience:
- Bachelor's degree in business administration, healthcare administration, or related field required. An advanced degree is preferred.
- 10+ years of progressive experience in a managed care or healthcare organization, with significant operational and strategic leadership experience.
- Significant operations and Medicare/MediCal/ACA program experience and full risk business management experience.
- In-depth understanding of managed care operations, Medicare Advantage, MediCal programs, and financial management within the healthcare industry.
- Familiarity with regulatory compliance and industry trends is crucial.
Salary range: $235k-$250k + bonus potential.
To further explore this opportunity, express interest, or share referrals, please contact Amy Jones:
Amy Jones, Senior Executive Search Consultant
Morgan Consulting Resources, Inc. ~ Healthcare Executive Search
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