Executive Director, Commercial Products

Job Summary

The Executive Director, Commercial Products (L.A. Care Covered, PASC-SEIU) will oversee the quality, compliance, and operational performance of L.A. Care’s commercial products. This includes Covered California and the PASC-SEIU Homecare Workers Health Care Plan. The position is responsible for delivering top and bottom line growth, ensuring compliance and quality score results, and driving continuous process and product performance improvements.

Duties

• In collaboration with internal key stakeholder partners, ensure risk adjustment transfers are minimized and/or medical cost trend targets are met for respective lines of business.
• Provide leadership to assure the effective and efficient operational management of multiple functions or departments.
• Drive for continuous process and product performance improvements and collaborate with other Executive Directors to work across product lines, applying influence to ensure operational enhancements are scalable.
• Lead respective teams and collaborate with key stakeholders at all levels within the organization to analyze current customer base, market needs, and trends, identifying potential opportunities for increased efficiencies and capabilities.
• Explore potential for additional revenue streams and/or new business development opportunities for products lines where applicable.
• Negotiate Service Level Agreements (SLAs) with organization-wide departments for his/her specific population segment product.
• Meet and communicate regularly with organization-wide operations, non-operations, and clinical leaders to resolve issues and manage negative trends, particularly focusing on enrollment accuracy, timely claims payments, member service responsiveness, network development, provider relations, data reporting, care management, marketing, and sales.
• Develop goals, objectives, and actions plans for assigned staff, including full management responsibility for hiring, performance reviews, salary reviews, and disciplinary matters for direct reporting employees.

Qualifications

• Education: Bachelor's degree preferred, but not required.
• Experience: At least 10 years of business experience in the insurance/managed health care industry, at least 10+ years of experience managing staff and leading teams, and experience working within a matrix management structure to deliver results.
• Experience: Must have experience in managing multiple products within a commercial health plan, experience with outside regulators, governmental entities, etc., broad knowledge of managed care, government programs, or other product lines, strong business and managed care acumen, strategic thinking, good planning, excellent communication, negotiation, and financial management skills, proven execution against aggressive objectives, strong organizational leadership, administration, analytical, and interpersonal skills.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retail Plans
• Medical, Dental, and Vision
• Wellness Program
• Volunteer Time Off (VTO)