The Associate Vice President (AVP),Medi-Cal Contract Management (Los Angeles) is the primary Care1st contact in Medi-Cal two plan model counties. Given the importance of the relationship with the Primary plans, the AVP is an integral member of the Care1st team in managing the relationship.
The AVP will coordinate all aspects of business with the COO, President, and Care1st Operating Committee, and is an integral leader that is planning, supporting and ensuring tactical execution of the contract . The role is responsible for numerous touch points at all levels in the organization, for critical responses and partnerships between the Primary Plan and Care1st. Essential Functions and Key Responsibilities:
Interface and manage the direct relationship with Primary Plan. Represents Care1st’s professionally and knowledgably, advocating as required in Care1st interests in support of the business strategy with Primary Plan. Responsible for the oversight of projects and submissions to Primary Plan to ensure compliance with the contract, including updates to member materials, Marketing Plan, Annual Formulary, Annual Quality Improvement Plan. Manages the Medi-Cal quarterly reporting requirements to ensure timeliness and accuracy. Assists with management of the Primary Plan and DMHC audits, and coordination of responses regarding Corrective Action Plans. Participates in DHCS All Plan CEO Quarterly meetings and California Association of Health Plans (CAHP) State Sponsored meetings, along with statewide CAHP workgroups when appropriate. Work across teams at Care1st to gather input and coordinate intelligent and thoughtful responses to Primary Plan inquiries, including the annual audits and corresponding Corrective Action Plans. Work with Legal and Government Affairs to understand and anticipate federal and state requirements and timelines as we interpret them and execute internally. Partners with Legal in coordination of local matters, involving Blue Shield corporate or outside counsel as needed. Coordination of timelines, product, legal, and operations around the key milestones and deliverables is critical. This role is a key link between Primary Plan and Care1st operations teams to ensure alignment. Lead review and actionable recommendations for Primary Plan legal documents related to performance guarantees, and service agreements/contract requirements. Minimum and Preferred Qualifications:
- 5 + years in leadership contract management role.
- Comprehensive knowledge of health care and specifically of Medi-Cal, including the requirements of DMHC and DHCS.
- Knowledge of the complex financial framework of DHCS Rate Structure.
- Proven ability to create and maintain strong ties within the community via relationships with County, City, and local leaders.
- Ability to cultivate deep and long lasting relationships, internally and externally.
- Proven ability to collaborate and influence across business functions.
- Excellent influence and engagement skills in building alignment and accountability without formal ownership or authority over talent resources.
- Ability to build strong and sustainable relationships and the capability to interact within all levels of the organization (internally and externally).
- Exceptional verbal and written communication, including an ability to communicate effectively at an executive level.
- Ability to work cooperatively and strategically in a team environment with all levels of professional, technical and administrative staff and to integrate resources on a timely and organized basis
- Ability to present information clearly and concisely to various audiences (internally and externally).