A Clinical Director directs and manages a medical practice, clinic, hospital, or other clinical setting. Organizes and manages of staff physicians, policy implementation, and ensures that standards for medical care are communicated and maintained.
SENIOR VICE PRESIDENT, HEALTH PLAN GROWTH & STRATEGY-ONSITE BLEHEALTH, LLC - 3.8
Pomona, CA Job Details Full-time $100,000 - $140,000 a year 12 hours ago Benefits Health insurance Qualifications Revenue growth Business development management Contract management Economics Economic experience in healthcare Medicare Market analysis Managed care organization experience Client relationship development Contract management experience in healthcare Bachelor's degree Health insurance knowledge Business alliance strategy Sales development Contracts Networking through strategic partnership building Medicaid Business development within healthcare Strategic partnerships Healthcare reimbursement methods Senior leadership Terms and conditions negotiation Full Job Description
SENIOR VICE PRESIDENT, HEALTH PLAN GROWTH & STRATEGY
Company:
BLEHEALTH, LLC
Department:
Executive Leadership /
Growth & Strategy Reports To:
Chief Executive Officer Employment Type:
Full-Time, Executive Leadership
POSITION SUMMARY BLEHEALTH
is seeking an accomplished Senior Vice President of Health Plan Growth & Strategy to lead the organization's health plan growth, payer contracting strategy, strategic partnerships, market expansion, and long-term business development initiatives. This executive will be responsible for expanding BLEHEALTH's relationships with Medicaid managed care organizations, Medicare Advantage organizations, health systems, provider organizations, government agencies, and other healthcare partners. The SVP will initially focus on maximizing BLEHEALTH's presence throughout California while developing and executing a disciplined strategy for expansion into additional states, and countries. The ideal candidate will have significant experience within a Medicaid managed care organization, Medicare Advantage plan, population health organization, or comparable healthcare organization and will understand how health plans evaluate, contract with, implement, and monitor external provider and service organizations. This is a growth and revenue leadership position . Success will be measured by new contracts, expansion of existing contracts, new markets entered, strategic partnerships developed, and revenue generated.
KEY RESPONSIBILITIES A.
Develop and execute BLEHEALTH's comprehensive health plan growth strategy. Identify and pursue new contracting opportunities with: Medi-Cal managed care plans Medicaid managed care organizations nationally Medicare Advantage organizations Health systems Physician organizations Accountable care organizations Government healthcare programs Other healthcare organizations Build relationships with senior executives and decision-makers within targeted organizations. Establish
BLEHEALTH
as a preferred partner for population health, care management, community-based services, and high-risk member engagement. B.
Develop executive-level relationships with:
Health plan CEOs Chief Medical Officers Chief Operating Officers Medicaid Presidents Network executives Population health executives Care management executives Community health executives Provider network leadership Contracting executives Represent
BLEHEALTH
at executive meetings, conferences, industry events, and strategic partnership discussions. Maintain ongoing relationships rather than limiting contact to contract negotiations. C. Develop a formal healthcare business-development pipeline. Identify opportunities before formal RFPs are released whenever possible. Maintain accurate pipeline forecasting and provide regular reports to the CEO. D. Lead the business strategy surrounding health plan contract negotiations. Work collaboratively with legal counsel, finance, compliance, operations, and clinical leadership.
Evaluate:
Reimbursement Payment models Performance requirements Service expectations Quality requirements Geographic scope Member volume Reporting requirements Financial risk Value-based payment opportunities The SVP is not expected to replace legal counsel but should understand healthcare contracting sufficiently to lead commercial negotiations.
REQUIRED QUALIFICATIONS
Bachelor's degree required. Advanced degree in healthcare administration, business, public health, or related discipline preferred. Approximately 10+ years of progressive healthcare leadership , managed-care, payer, population-health, business-development, or contracting experience. Demonstrated experience working with Medicaid managed care organizations. Strong understanding of healthcare payer-provider relationships. Experience developing or negotiating healthcare contracts. Demonstrated record of generating new healthcare business. Strong executive communication and presentation skills. Ability to communicate effectively with health-plan executives. Experience developing strategic partnerships. Strong understanding of healthcare reimbursement and managed-care economics. Ability to analyze new healthcare markets. Willingness to travel for health-plan meetings, conferences, and market-development activities.
STRONGLY PREFERRED EXPERIENCE
Ideal previous employers may include national or regional: Medicaid managed care organizations Medicare Advantage organizations Integrated health systems Population health organizations Particularly valuable experience includes previous responsibility for: Medicaid Provider networks Population health Care management Network development Contracting Government programs Value-based care
IDEAL CANDIDATE PROFILE
The ideal candidate is not simply a salesperson.
BLEHEALTH
needs an executive who understands: Healthcare + Medicaid + Health Plans + Relationships + Contracting + Strategy + Revenue The individual should be capable of walking into a meeting with a Medicaid health plan president or senior executive and credibly discussing: Population health Member outcomes Medicaid strategy Care management Network needs Reimbursement Quality Cost reduction Community services Value-based care The candidate should have an established healthcare network and be capable of opening doors that
BLEHEALTH
would otherwise take years to access.
LEADERSHIP CHARACTERISTICS
The successful candidate should demonstrate: Executive presence Strategic thinking Accountability Strong relationship-building skills Negotiation ability Financial understanding Healthcare industry knowledge Initiative Integrity Results orientation Entrepreneurial thinking This executive must be comfortable operating in a growing organization where building new systems and opportunities is part of the position.
COMPENSATION STRUCTURE
$140K + significant performance compensation
CRITICAL HIRING REQUIREMENT
The strongest candidate should be able to demonstrate: Which health plans they have worked with. Which executives they already know. Which contracts they have personally helped secure. How much revenue they have generated. Their experience with Medicaid managed care. Their experience expanding healthcare services into new markets. Their understanding of payer contracting.
