Highmark · 21 hours ago
SVP and President Medicaid Business
Pittsburgh, PA
Full-time
Onsite
Senior Level, Lead/Staff
10+ years expHighmark Inc. is a leading healthcare company, and they are seeking a Senior Vice President of Medicaid to oversee the strategic direction and operational execution of their Medicaid & D-SNP business. This role involves leading a team to deliver high-quality healthcare solutions while managing financial performance and regulatory relations.
Health CareHealth InsuranceInsuranceWellness
Responsibilities
Develop and execute a comprehensive strategic plan for the Medicaid business, aligning with Highmark's overall mission and growth objectives
Identify and capitalize on market opportunities, address competitive threats, and drive innovation in Medicaid service delivery
Through matrix partners, leads the strategic identification, development and optimization of clinical programs while fostering key community relationships and partnerships, ensuring alignment with Medicaid's quality strategies and driving improved business performance and member clinical outcomes
Oversee the financial performance of the Medicaid line of business, including enrollment, growth, revenue management, cost control, and profitability
Develop and monitor key performance indicators (KPIs) to track progress against financial targets and identify areas for improvement
Ensure efficient and effective operations across all aspects of the Medicaid business, including member enrollment, claims processing, care management, and quality improvement
Implement best practices to streamline processes, reduce administrative costs, and enhance the member experience
Develop and maintain a high-quality provider network that meets the needs of Medicaid members
Negotiate contracts with hospitals, physicians, and other healthcare providers to ensure competitive rates and access to care
Foster strong relationships with provider partners to improve collaboration and care coordination
Serve as the primary point of contact for federal & state Medicaid agencies and other regulatory bodies
Develop and maintain strong relationships with key government officials, advocate for Highmark's interests, and ensure compliance with all applicable laws and regulations
Represent Highmark in relevant Medicaid industry trade groups and associations
Monitor and shape legislative and regulatory developments, participate in policy discussions, and contribute to the advancement of Medicaid best practices
Build and lead a high-performing team of Medicaid professionals
Foster a culture of collaboration, innovation, and accountability
Provide coaching, mentoring, and development opportunities to support employee growth and advancement
Develop and implement community engagement initiatives to address the social determinants of health and improve the well-being of Medicaid members
Partner with community-based organizations to provide access to resources and support services
Qualification
Required
Bachelor's degree in Business Administration/Management, Healthcare/insurance related field
Minimum of 10 years of progressive leadership experience in the Medicaid industry or related government business
7 years in health insurance leadership
5 years of effective P&L Management or related financial management
Preferred
Master's degree in Healthcare Administration, Business Administration, or a related field
Previous experience securing, retaining, and operating across multiple states and contracts
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
Company data provided by crunchbase