President, Health Plan Southeast
The French Group has been retained by one of the nation’s most reputable health plans to identify a strategic yet hands-on CEO with an inspirational leadership style and passion for making a difference with the underserved population.
The Plan President is responsible for the overall strategic direction and performance of the health plan to include fiscal, operational, legislative, regulatory and human capital oversight. In addition to P&L accountability, the Plan President is responsible for developing and implementing business strategies consistent with corporate’s mission and values to create a culture of accountability, execution, quality, compliance, profitable growth and innovation. This includes the establishment of a robust provider network and creating a strong, cohesive leadership team to attain the organization’s immediate and long-term goals.
The Plan has longstanding relationships in the state, partnerships with community groups and a model of care developed by listening to the needs of the communities served.
This position involves leading a management team of direct reports and shared services staff, and managing within a matrix environment. This position is the primary executive liaison with the state’s regulator of Medicaid and LTSS programs.
1. Health Plan Leadership/Strategy: Demonstrated experience creating and leading high performing matrix teams to achieve goals, create bench strength and ensure long term growth objectives. Develop the strategy, business operating plan, conduct periodic reviews/assessments and develop interventions as needed. Identifies trends and evaluates options to recommend programs and policies to meet changing needs. Oversees the day-to-day operations of the staff and provides mentoring and professional development.
2. Manage Regulatory Requirements and Ensure State Contract Compliance: Develop and manage key State and legislative relationships. Participates in multiple state level meetings to ensure current understanding of regulatory and legislative impact to Plan development. Maintains full understanding of the state contract requirements. Ensure contract requirements are being met, reports are accurate and delivered in a timely manner. Participate in rate setting discussions. Communicates state agency requirements for program implementations and coordinates with internal resources to implement contract requirements. Acts as liaison with state and regulatory agencies in communicating ongoing implementation progress.
3. Manage Other Key Stakeholder Relationships: This may include representatives of provider, public, and community-based organizations specifically those focused on serving complex populations. Maintains awareness of political landscape by establishing relationships with lobbyists and attending meetings with legislators. Community involvement to maintain current market knowledge and enhance marketing or awareness of Plan.
4. Experience Meeting/Exceeding Annual Operating Objectives: Responsible for Plan’s performance management, administrative (SGA and capital) and medical expense budgets including improvement activities. Responsible for growth, revenue, cost of care, operating gain, quality results and operational efficiency/effectiveness.
5. Have Knowledge of and Participate in Health Plan Operations: Establish effective programs and processes across all functional areas to implement new programs and ensure high satisfaction of members, providers and State customers including but not limited to:
• Healthcare services (medical and pharmacy management, population health programs)
• Quality (HEDIS, NCQA, etc.)
• Provider network (contracting, servicing, pricing strategy)
• Marketing/community relations (growth)
6. Attends and acts as a thought leader in national meetings where the company`s product and services are a focus. Establishes the company as a thought leader in this space to help set policy.
7. Promote the organization’s mission, vision and culture by supporting staff through skill development and performance management.
• Successful track record in government sector health plan leadership to include P&L experience
• 10+ years of relevant leadership experience in the managed care/health care field
• Inspirational, intuitive leader with a focus on transparency to create trust and constructive collaboration
• Intuitive assessment skills with regard to talent selection and development.
• Strong working knowledge of Medicaid, Medicare and MLTSS products and a passion for creating a unique model of care that integrates the management of behavioral and physical health services.
• Ability to effectively represent organization and company in external venues with proven track record negotiating and maintaining State, community and legislative relationships
• Ability to understand set strategy/objectives, assign accountability and monitor meaningful action steps
• Strong financial management and analytic skills
• Exceptional organizational and project management skills
• Excellent communication and presentation skills
BA/BS degree required; Master’s preferred
Tricia French RN, BSN
President / CEO
The French Group