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Market Manager - Texas Medicaid - (17007521)

  • Location: Bedford, TX
  • Salary:
  • Posted: Oct 5

Click here to view a full job description and apply if qualified!

 

Description

 Responsible for the financial and operational performance and operations of the Texas Medicaid business, including performance of matrix partners and maintenance of State relations. Responsibilities include direct oversight of operations, including network, service coordination, utilization management and clinical program oversight, as well as coordination with all relevant matrix partners and State partners to ensure operational success.
Summary: Reports to the General Manager, Medicaid. Assist in the development of the market strategy for the Medicaid products with short and long range goals supported by comprehensive business plans. Drives change leadership to best align the Texas market with an evolving business model that maintains regulatory compliance. Demonstrate commitments to contractual and regulatory compliance. Achieve membership, revenue growth and profitability targets. Enhances the company reputation by collaborating with customers, government, community organizations, and employees.

Responsibilities:

  • Lead financial / operational performance and drive activities of directors and managers and their respective functions.
  • Accountable for oversight of all functions within Medicaid, includes Network Operations, Clinical Operations, Clinical Programs, Quality and Utilization Management.
  • Has strong P&L orientation; allocates resources and manages operating expenses to maximize P&L while managing risk.
  • Prioritizes the development of constructive partnership with state and federal partners.
  • Ensures the business unit collaborates with the compliance and legal department to drive prudent and sustainable growth.
  • Develop and maintain strong external relationships with key business partners to include doctors, hospitals and ancillary service providers. Serve as the face of Cigna-HealthSpring Medicaid within the market to these external constituents.
  • Effectively creates, manages and maximizes key relationships to create synergies, alliances and new opportunities.
  • Evaluates the current human capital in the market, ensure the right person is in the right role, provides developmental plans, and where appropriate, makes effective decisions which will strengthen the market team and overall organization.
  • Responsible for the operational management of the provider network, which may include network development, contracting, credentialing, provider relations, provider services, and operations. Responsible for providing policy administration for provider networks and ensuring contractual compliance with governmental regulations.
  • Develops, implements and manages the adoption of controls that allow the organization to quickly identify trends and potential issues and address them in a timely manner.
  • Understands and implements business controls across functions to ensure that there is clear understanding and ownership of key scorecard measurements (quality, efficiency, effectiveness, cost, service) as well as driving continuous improvement over time.
  • Motivates and develops teams through ongoing organizational and industry change – developing and aligning with strategies of the future. Includes the ability to drive effective Change Leadership practices to provide the proper amount of support to our teams through these transitions.
  • Leverages marketing, advertising and local market funds to promote the brand within the local market.


Click here to view a full job description and apply if qualified!


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