SVP, Kaiser Permanente Health Plan - Pacific Northwest Market
About the role
The Senior Vice President, Kaiser Permanente Health Plan (SVP, KPHP) is a collaborative, strategic leader responsible for the overall health plan performance, growth, and profitability across all product lines within their market(s).
Responsibilities
Collaborate with regional president(s) (RP), Executive Medical Director(s) (EMDs) and the Medical Foundation (KPMF) (WA) to align and lead operations and initiatives to achieve market leading growth and total margin.
Partner with RPs, EMDS and KPMF to define health plan strategic priorities by defining revenue sufficiency, target markets, products, and capital needs. Complete competitive intelligence and market SWOT development and product market fit to ensure strategies are aligned across geographies, business lines, and products.
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.
Partners with RP to lead rate setting and partners with underwriting and actuarial teams to ensure competitive pricing, revenue sufficiency, and regulatory compliance.
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.
Partner 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.
Foster strong relationships to improve retention, satisfaction, and market presence.
Partner with marketing and sales teams to develop and execute local market strategies for brand awareness, member acquisition, and retention.
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.
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.
Partner 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.
Partner with national function leaders to ensure compliance with all federal and state regulations across product lines, including Medicare Advantage, Medicaid, and ACA marketplaces.
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.
Implement measurement systems and operating models to track growth and margin performance, aligned with enterprise and health plan priorities.
Requirements
Minimum fifteen (15) years of progressive leadership experience in the healthcare industry, with at least seven (7) years in a senior executive role within a health plan or payer organization.
Bachelor's degree in business administration, Healthcare Administration, or related field required.
Proven track record of driving revenue growth, managing P&L, and achieving financial targets in a complex, multi-product health plan environment.
Extensive experience with Medicare Advantage, Medicaid, and commercial product lines (individual, small business, midsized, large group, and national accounts).
Demonstrated success in network management, medical cost containment, and go-to-market strategies.
Strategic vision with the ability to translate goals into actionable plans.
Strong financial acumen, with expertise in underwriting, actuarial analysis, and P&L management.
Exceptional leadership and team-building skills, with a focus on collaboration and mentorship.
Outstanding communication and relationship-building abilities to engage with customers, brokers, providers, and regulators.
Deep understanding of healthcare regulations, including ACA, Medicare, and Medicaid requirements.
Proven ability to influence a complex organization to ensure that performance standards are customer-driven.
Excellent creative and analytical problem-solving skills. Ability to credibly influence decision makers to act on fact-based recommendations.
Strong entrepreneurial style and customer focus. Proven leadership in driving flawless administrative and internal functions in support of the customer.
Prior experience working in a complex payer organization, possessing facilitation, negotiation, and consensus building skills.
MBA preferred.
Qualifications
Comfortable with ambiguity and uncertainty; the ability to adapt nimbly and lead others through complex situations.
A leader who is viewed by others as having a high degree of integrity and forethought in their approach to making decisions; the ability to act in a transparent and consistent manner while always considering what is best for the organization.
The ability to persevere in the face of challenges and exhibit a steadfast resolve and relentless commitment to higher standards, which commands respect from followers.
A leader who is self-reflective and aware of their own limitations; leads by example and drives the organizations performance with an attitude of continuous improvement by being open to feedback and self-improvement.
Naturally connects and builds strong relationships with others, demonstrating strong emotional intelligence and an ability to communicate clearly and persuasively.
An ability to inspire trust and followership in others through compelling influence, powerful charisma, passion in their beliefs, and active drive.
Encourages others to share the spotlight and visibly celebrates and supports the success of the team.
Creates a sense of purpose/meaning for the team that generates followership beyond their own personality and engages others to the greater purpose for the organization.
Skills
Strategic planning and alignment
Financial management and P&L management
Healthcare regulation and compliance
Network management and medical cost containment
Go-to-market strategies
Leadership and team-building
Communication and relationship-building
Problem-solving and analytical skills
Regulatory oversight and compliance
Measurement and accountability
Benefits
Not specified.
Pay
Not specified.
Schedule
Not specified.