ED, Medicaid Hawaii

About the Role

Reporting to the National Senior Vice President of Medicaid and accountable to the Regional President of the Hawaii region, the Executive Director of Medicaid, Hawaii is a key leader of the Medicaid national line of business. This role is responsible for leading, managing, and coordinating Kaiser Permanente’s (KP) Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships, and related activities in Hawaii. The position involves close coordination with KP regional, national, and shared service leaders supporting Medicaid operations and services for beneficiaries in Hawaii and across all KP regions. It also includes responsibilities for state Dual Eligible Special Needs Plan (D-SNP) functions, in collaboration with KP’s Medicare line of business leaders.

The Executive Director maintains relationships and represents KP with external partners and stakeholders, including regulators, safety net providers, other health plans, industry associations, advocacy groups, and media. This role requires extensive coordination with KP’s medical care delivery system, including the Hawaii Permanente Medical Group.

Responsibilities

• Lead, manage, and coordinate strategy, planning, health plan operations, compliance, regulatory and industry relationships, and related activities in Hawaii.
• Collaborate with national, shared service, and Hawaii market leaders to support implementation of Medicaid and D-SNP strategy, regulatory, and operational requirements.
• Lead, manage, mentor, and develop Medicaid and D-SNP leaders and staff in Hawaii and across KP to provide subject matter expertise for regulatory compliance.
• Maintain a deep understanding of state and federal Medicaid, CHIP, D-SNP, and related legislation and regulations, and their impact on KP’s strategy and operations.
• Monitor the national and Hawaii health plan and provider competitive environment as it relates to Medicaid, dual eligibles, and vulnerable populations.
• Lead and coordinate the development, implementation, and modification of Medicaid and D-SNP participation strategies in Hawaii.
• Align regional Medicaid and D-SNP strategy with regional and national line of business, care delivery, and functional strategies.
• Collaborate with regional and national government relations to monitor and influence legislation and regulation related to Medicaid and D-SNP.
• Develop and execute legislative, regulatory, and advocacy strategies to ensure adequate payment levels and efficient regulation for Medicaid and D-SNP plans.
• Collaborate with National Medicaid Compliance to ensure KP functions are compliant with state and federal Medicaid and D-SNP requirements.
• Identify and support implementation of changes needed to achieve and maintain compliance.
• Establish, modify, and monitor key performance metrics to track performance and compliance of Medicaid and D-SNP lines of business.
• Collaborate with regional and national finance teams to monitor and manage financial performance.
• Implement changes to Medicaid and D-SNP organizational structure, staffing, and processes to improve effectiveness and efficiencies.
• Support initiatives to improve financial performance of Medicaid and D-SNP lines of business.
• Manage KP’s relationships with state Medicaid agencies.

Requirements

• Minimum twelve (12) years of professional experience in the health insurance business or in a consulting role focused on Medicaid, Medicare, and other government-sponsored programs or care delivery systems for low-income and vulnerable populations.
• Minimum five (5) years of prior healthcare leadership experience, including Medicaid and other state-sponsored programs.
• BA in business or related field required.
• Extensive knowledge and expertise in Medicaid, CHIP, and D-SNP.
• Demonstrated experience and success in health plan and/or care delivery operations and business development in Medicaid Managed Care.
• Understanding of KP and integrated health plan and care delivery models and issues.
• Competencies in strategic, financial, and operational planning and program management.
• Ability to lead in a highly matrixed organization, including establishing, leading, and collaborating effectively through influence and relationships rather than direct reporting lines.

Preferred Qualifications

• Experience in health care management and the Medicaid regulatory environment in Hawaii.
• Experience working with state Medicaid agencies on innovative models, contract negotiations, and rate setting.
• Experience in D-SNP, Medicare Advantage, or programs serving dual eligibles.
• Master’s degree preferred.

Pay

$243,000 - $303,750 / year. Kaiser Permanente strives to offer a market-competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of the total rewards package. Actual base pay will be determined at offer based on labor market data, internal alignment, and a candidate’s relevant work experience, education, certifications, skills, and geographic location.

Schedule

• Full-time, standard worker.
• Scheduled weekly hours: 40.
• Shift: Day (Monday–Friday, 08:00 AM – 05:00 PM).
• Travel: Yes, 10% of the time.
• Work setting: Flexible. Worker location must align with Kaiser Permanente’s Authorized States policy.