National Association of Latino Healthcare Executives · 1 day ago
SVP, Kaiser Permanente Health Plan – Central Market
Denver, CO
Full-time
Onsite
Director/ExecutiveThe National Association of Latino Healthcare Executives is seeking a Senior Vice President for Kaiser Permanente Health Plan in the Central Market. This role involves strategic leadership for health plan performance, focusing on growth, profitability, and collaboration with various stakeholders to enhance member experience and operational success.
Health CareHospitalMedical
Responsibilities
Partnership with Regional President(s) and Executive Medical Director(s): Collaborate with regional president(s) (RP), Executive Medical Director(s) (EMDs) and the Medical Foundation (KPMF) to align and lead operations and initiatives to achieve market leading growth and total margin
Strategic Planning & Alignment: Partner with RPs, EMDS and KPMF to define health plan strategic priorities by defining revenue sufficiency, target markets, products, and capital needs. Completes competitive intelligence and market SWOT development and product market fit to ensure strategies are aligned across geographies, business lines, and products
Performance & Growth Management: Drive financial and health plan operational success by partnering with regional leaders, supporting sustainable health plan revenue growth, profitability, and market competitiveness across all product lines
Rate Setting & Underwriting: Partners with RP to lead rate setting and partners with underwriting and actuarial teams to ensure competitive pricing, revenue sufficiency, and regulatory compliance
Network Management: Collaborate with national function leaders and regional president to design, build, and maintain provider networks that support high-quality, cost-effective care and member satisfaction
Medical Cost Trend Management: Partner with the national function leaders and regional president and seek consultation of EMD and KPMF to support analytic and contracting strategies to control medical cost trends while maintaining quality of care and member satisfaction
Drive local market accurate and comprehensive diagnostic coding: Collaborate with national function leaders, Care Delivery Operations, regional president and EMDs to provide complete diagnostic coding for all risk-adjustable business lines, including individual, small business, Medicare, and Medicaid
Customer & Broker Relationships: Foster strong relationships to improve retention, satisfaction, and market presence
Go-to-Market & Sales Leadership: Partner with marketing and sales teams to develop and execute local market strategies for brand awareness, member acquisition, and retention
Line of Business Leadership: Partner with RP and EMD, with direct responsibility for contributing to line of business P&L results, focusing on margin targets through growth, revenue optimization, effective management, and risk mix. Oversees health plan administrative costs and works with national leadership to maintain the right mix of business and revenue within local markets
Commercial Lines of Business
Drive financial and operational performance across commercial product lines, including individual
Set competitive rates and benefits to support growth and market needs
Partners to ensure network adequacy, compliance, and member satisfaction
Partner to support affordability action plans and analyze medical spending
Medicare Line of Business
Optimize benefits and bids to maximize competitiveness
Maintain compliance with CMS regulations and drive quality ratings
Improve risk adjustment accuracy
Partner to ensure effective population health programs and support affordability action plans
Works with key leaders to support the success of the Medicare Stars program, inclusive of action plans aimed at achieving high MCAHPS and NPS
Medicaid Line of Business
Partner to ensure effective population health programs and support affordability action plans
Partners to ensure compliance with CMS and state regulations
Partner for network adequacy and member satisfaction through collaborative action plans aimed at achieving high CAHPS and NPS
Regulatory & Compliance Oversight: Partner with national function leaders to ensure compliance with all federal and state regulations across product lines, including Medicare Advantage, Medicaid, and ACA marketplaces
Team Leadership: Lead and mentor a cross-functional matrixed team across business management, network, underwriting, actuarial, and government affairs functions. Build a high performing, engaged workforce aligned with KP-s mission and objectives
Measurement & Accountability: Partner with national function leaders to implement measurement systems and operating models to track growth and margin performance, aligned with enterprise and health plan priorities
Qualification
Required
Strong communication skills
Adaptability
Ability to build consensus in a complex, matrixed environment
Experience in overseeing line of business performance for membership growth, mix, and rate setting
Experience in underwriting and health plan operations
Experience in managing customer and broker relationships
Ability to evaluate trend and trend drivers for customer rate rationalization and affordability management
Experience in network management and contracting
Experience in operational setup, billing, and payment integrity
Ability to collaborate with leaders at national, regional, and care delivery levels
Experience in strategic health plan line of business membership opportunities and challenges
Ability to create and implement business plans
Experience in developing and executing health plan strategies
Ability to anticipate changes in policy and use market insights and data
Experience in assessing membership trends to spot and pursue growth prospects
Ability to turn findings into practical strategies that drive improvement in health plan performance
Experience in contributing to profit and loss results
Ability to ensure financial performance aligns with budget and long-term plans
Experience in ensuring regulatory compliance
Commitment to Kaiser Permanente's mission of integrated, value-based care
Experience in partnership with Regional Presidents and Executive Medical Directors
Experience in strategic planning and alignment
Experience in performance and growth management
Experience in rate setting and underwriting
Experience in medical cost trend management
Experience in driving local market accurate and comprehensive diagnostic coding
Experience in fostering strong customer and broker relationships
Experience in go-to-market and sales leadership
Experience in line of business leadership
Experience in driving financial and operational performance across commercial product lines
Experience in optimizing benefits and bids for Medicare
Experience in maintaining compliance with CMS regulations
Experience in improving risk adjustment accuracy
Experience in supporting the success of the Medicare Stars program
Experience in ensuring compliance with CMS and state regulations for Medicaid
Experience in leading and mentoring a cross-functional matrixed team
Experience in implementing measurement systems and operating models to track growth and margin performance
Company
National Association of Latino Healthcare Executives
The National Association of Latino Healthcare Executives is a hospital and healthcare organization.
Founded in 2005
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Jackie Sifuentes, MBA, LSSYB
Co-Founder La Mesa Emerging Leaders Mentorship Program for Early Careerists
Company data provided by crunchbase