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The Market Plan President Wellpoint South Carolina is responsible for the fiscal, operational management, legislative and regulatory objectives of an assigned Health Plan. A Health Plan at this level is large and complex in operating factors, which may include alliance or other joint venture relationships. Primary duties may include but are not limited to:
Establishes strategies that create or sustain a competitive advantage. Aligns strategy to achieve business goals and builds a culture of accountability.
Manages the P&L of the assigned Health Plan.
Oversees operating gain, growth, cost of care commitments, revenue, quality, and accreditation goals.
Develops and manages key State regulatory and legislative relationships and processes, including premium rates, covered populations, eligibility, benefit design, networks, administrative requirements, and new products.
Collaborates with shared services support to reach Health Plan objectives. Ensures contract compliance and provides oversight of risk management programs.
Manages customer and regulatory relationships, including state regulatory and legislative processes.
Role will lead the health plan and be P&L owner driving overall success of the plan.
Establish and maintain growth partner relationships on behalf of the health plan.
Act as face of SC Wellpoint with regulators, community and network, including meetings, phone calls, etc. and establish relationships.
Guide and lead implementation teams to ensure on track for program delivery, messaging and Gate delivery.
Lead teams to ensure onsite presentation in line with SC Wellpoint messaging and state priorities.
Due diligence of South Carolina Wellpoint program components, contract, State priorities, policies and procedures, network and GR environment
Responsible for hire of South Carolina health plan state regulatory positions Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications:
Requires a BA/BS degree in a related field.
minimum of 12 years of related experience.
8 years of experience in government sponsored health insurance programs and prior leadership experience; or any combination of education and experience, which would provide an equivalent background.
Medicaid Health Plan experience.
Travel may be required.
Must be located the Columbia South Carolina area.
Preferred:
Master’s degree preferred.
Health Plan Start up experience.
Experience with RFP’s