VP, General Manager Government Programs - CA Market

Job Summary:

The Vice President and General Manager, Government Programs is a senior leadership role accountable for driving sustainable growth across the Medicare Advantage (MA) business line. This role is responsible for overseeing the strategic direction, growth, quality, clinical outcomes, network development, and financial performance of the Medicare Advantage line of business in designated local or regional market(s).

This role requires a leader with expertise in Medicare Advantage, network development, and integrated delivery systems. Success in this role requires strong collaboration and partnership with key internal and external stakeholders (including providers and government regulators) to drive operational excellence, member satisfaction, and financial success.

Essential Responsibilities:

• Strategic Regional Market Leadership for the MA Line of Business:
• As an integrated member of the regional market leadership team(s), develop and implement competitive, market-specific strategies to enhance financially sustainable Medicare Advantage growth and market share, achieve Kaiser Permanente (KP) target economics, and create alignment with the KP integrated care and coverage model to drive a differentiated value proposition around affordability and quality for CMS and members.
• Lead the positioning of KP by leveraging high-level collaboration and influencing skills to drive exceptional performance within a large, complex, multi-regional enterprise.
• Collaborate with regional market leadership, PMG, care delivery, National Health Plan (NHP) functional leaders, and other KP system stakeholders (e.g., Foundation, Federation, Medicare executive sponsors) to align market operations and performance with the organizations mission, vision, and sustainable, value-based care strategies.
• Ensure all market specific strategies align with the overall balanced portfolio of the regional market economic targets and strategic growth objectives.
• Financial Performance:
• Manage the regional market P&L for the MA line of business, ensuring target economics are achieved through revenue optimization and effective cost management.
• Develop and monitor budgets, forecasts, and financial plans to support strategic and operational initiatives, and lead regional MA performance management through a defined operating model.
• Collaborate with actuarial, national Medicare finance (NMF), risk adjustment, and program office teams to align membership forecasting with strategic market objectives, ensure the accuracy and completeness of risk adjusted revenue, drive identification, execution, and regular monitoring of medical cost initiatives, recommend network strategies to optimize value-based care, and ensure administrative efficiency.
• Growth and Business Development:
• Identify and pursue opportunities for sustainable membership growth through product development, effective distribution channel management, and strategic partnerships within the KP integrated care and coverage model and through other external, value-based providers.
• Develop and execute market strategies to position KP for sustainable growth in Medicare Advantage by partnering with senior leaders in National Medicare Sales.
• Strengthen brand identity and member preference to maximize marketplace value and long term member tenure.
• Collaborate with National Marketing to develop and execute marketing strategies for growth in existing and new markets including marketing campaigns, advertising, marketing, marketing communications, brand, and public relations strategies that support MA strategic sales objectives and membership, revenue, and margin goals.
• Leads initiatives to improve member retention, experience, and competitive positioning through differentiated senior care models.
• Provide strategic guidance on product development, benefit design, and core competencies to ensure market competitiveness and alignment with customer needs.
• Recommend MA specific member experience improvement opportunities and drives initiatives across the organization.
• Quality and Clinical Outcomes:
• Implement programs (and define the demand) to improve clinical quality metrics, including Star ratings (HEDIS, CAHPS, HOS), ensuring integrated care delivery aligns with members needs and organizational goals.
• Partners with risk adjustment to align market specific prevalence and acuity data to clinical program development and network strategies.
• Collaborate with clinical leadership to develop and execute care management, disease management, and population health programs tailored to Medicare Advantage members, including Dual Eligibles.
• Network Development, Performance Management, and Provider Engagement:
• Drive MA/Duals specific innovation in care models through partnerships with providers and/or value-based vendors to address senior oriented population health needs, improve affordability, and enhance quality outcomes.
• Recommend and drive network strategy recommendations to meet the unique needs of Medicare Advantage membership in the KP regional market, inclusive of specific senior care, community aligned, value-based (and potentially risk bearing) providers.
• Monitor internal and external network performance metrics, including access, utilization, cost of care, and member outcomes, to ensure high-quality, efficient care delivery.
• Collaborate with clinical and operational teams to address network gaps from the perspective of CMS regulatory compliance, access, and availability standards, as well as performance against member experience and outcomes expectations.
• Foster collaborative relationships with PMGs and external providers through transparent reporting and joint initiatives focused on shared goals and continuous quality improvement.
• Operational Management:
• Monitors operations of the Medicare Advantage business, ensuring achievement of both member experience expectations and compliance with all federal and state regulations.
• Partners with NHP compliance and operations, surfacing potential risks through proactive management of leading indicators.
• Partners with government programs operational leadership to recommend and track synergistic efficiency opportunities across processes and systems.
• Regulatory Compliance:
• Ensure all regional operations comply with CMS guidelines, state regulations, and internal policies.
• Stay abreast of changes in Medicare (and Dual/Medicaid) regulations, as appropriate to the market and product portfolio, and adjust strategies accordingly.