Highmark · 1 day ago
VP Medicaid Markets CEO - PA
Pittsburgh, PA
Full-time
Onsite
Senior Level, Lead/Staff
10+ years expHighmark Inc. is seeking a VP Medicaid Markets CEO to lead the overall performance of a Medicaid plan, focusing on quality of care, service, and financial performance. The role involves developing strategic goals, managing relationships with key stakeholders, and ensuring compliance with federal and state regulations.
Health CareHealth InsuranceInsuranceWellness
Responsibilities
Perform management responsibilities including, but not limited to involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority
Develop strategic goals and business plans to be executed at the health plan. Collaborate on the development and oversee implementation and reporting of the annual short- and long-term strategic business plan, budget, and financial projections to include all reporting required by local, state, and federal officials/ agencies
Work with Actuary, Finance, Executive Leadership and key business partners, lead the state contract RFP or rate renewal activities to ensure the acquisition, retention, and profitability of the business. Tasks include facilitating the proposal or rate renewal process, preparing rate proposals and related materials for executive leadership review/approval and for submission to the state, and serving as business lead in negotiations with the state
Develop and maintain mutually beneficial relationships with key elected officials, key community organizations and other influential local entities in support of the state's Medicaid programs and members as well as market and community goals. Stay current with federal and state health care reform, legislative and regulatory activities and proposed changes, assessing impacts, advising Highmark's public and private positions and engaging as needed to shape regulatory and contract outcomes
Develop and maintain positive, mutually beneficial relationships with strategic provider partners within the market. Partner with and provide both strategic and tactical direction to the provider network contracting team to build and enhance the provider network and related vendors to achieve the care, service and financial goals. As needed, engage in provider relations escalated service issues to achieve high provider satisfaction and deliver quality care to members
Work with Highmark Compliance, provide strategic direction and tactic guidance to the compliance programs and practices to ensure full compliance to federal/state regulations and contract terms and conditions. In coordination with Highmark Compliance, provide business leadership to all compliance reviews, such as ERQ and ISCA, as well as other external organizations such as BCBSA and NCQA
Lead and manage the team and organization to execute our care and service commitments to our key constituents with a primary focus on serving and caring for our members. Work to continuously improve the health plans performance, minimize performance risks, and engage in escalated issues to achieve mutually satisfactory outcomes, with a focus on membership care and satisfaction
Qualification
Required
Bachelor's Degree in Business Administration/Management
10 years of Medicaid Experience
10 years in Management
Preferred
Master's Degree in Government
Company
Highmark
Highmark provides health insurance plans for individuals and businesses.
10001+ employees
H1B Sponsorship
Highmark has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (7)
2023 (19)
2022 (21)
2021 (18)
2020 (23)
Funding
Current Stage
Late StageTotal Funding
$27.3M2018-04-06Grant· $25M
2014-08-07Grant· $2.3M
Leadership Team
Deborah Rice-Johnson
CEO, Diversified Businesses at Highmark Inc. and Chief Growth Officer
Paul Sikora
CTO Provider Services
Recent News
2025-12-11
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