Executive Director, Commercial Products

Job Summary

The Executive Director, Commercial Products (L.A. Care Covered, PASC-SEIU) will take specific responsibility for delivering top and bottom line growth and outstanding compliance and quality score results for a population segment product of the L.A. Care Commercial portfolio. The position is responsible for strategically evaluating, planning and leading complex business initiatives that support the strategic goals of the product strategy and align with enterprise strategy. This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

This position will oversee the following products:
Commercial Products: This position is responsible for the quality, compliance and operational performance of L.A. Care’s commercial products that support the following direct lines of business:

Product: Covered California
L.A. Care Product Name: L.A. Care Covered, L.A. Care Covered Direct
Covered California is the state health insurance exchange for California residents. Their mission is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.  L.A. Care Covered serves eligible residents of Los Angeles County and is positioned for growth through member focused value added programs and services.  Members are provided health care and coordinated services through L.A. Care’s contracted network of providers, hospitals, pharmacies and ancillary service providers throughout Los Angeles County.  

Product: PASC-SEIU Homecare Workers Health Care Plan
L.A. Care Product Name:  PASC-SEIU Plan
L.A. Care offers the PASC-SEIU Homecare Workers Health Care Plan, also known as the PASC-SEIU Plan for eligible In-Home Supportive Services (IHSS) workers, who provide in-home services such as meal preparation and personal care services to Medi-Cal beneficiaries.  The Personal Assistance Services Council (PASC), as the employer of record, determines eligibility for PASC-SEIU Homecare Workers Health Care Plan.

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 where applicable collaborate with other Executive Directors to work across product lines, applying influence to ensure operational enhancements are developed to be scalable to meet changing market, consumer and provider demands.

Lead respective teams and collaborate with key stakeholders at all levels within the organization to analyze current customer base, market needs and market trends in order to identify potential opportunities for increased efficiencies and capabilities incorporating a scalable scope for development considers the future state. When required, drive end to end product life cycle for new products, program and service offerings across lines of business under a single to  market vision and strategy. 

Explore potential for additional revenue streams and/or new business development opportunities for products lines where applicable.  Where applicable obtain alignment with other Executive Director line-of-business  (LOB) owners to create business case and/or discussions for product governance. 

Lead the development of annual and long range business plans for respective lines of business.  Develop multi-year business plan that helps establish strategic goals of a target population segment product that aligns with overall product vision and enterprise strategic directions.  

Operations for product administration and other foundational building blocks that enable the member experience and the delivery of population segment products are provided through organization wide L.A. care departments serving all population segment products. The Executive Director works in close collaboration with cross functional business units across the enterprise to ensure appropriate and timely implementation of federal and state regulatory requirements as well as new products, programs and service initiatives.

Negotiate Service Level Agreements (SLAs) with those organization wide departments for his/her specific population segment product.

Meet and communicate regularly with organization wide operations, non-operations and clinical leaders and work closely with them to resolve issues and manage negative trends with particular emphasis on:  Enrollment for accurate and timely loading of members into L.A. Care systems and assignment of members to providers;  Timely and accurate claims payments; Member service responsiveness; Network development and provider relations;  Data reporting for KPIs and monthly financials; Care management and care coordination; Marketing and sales. 

Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

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.

Experience working within a matrix management structure to deliver results is critical.

Must have experience in managing multiple products within a commercial health plan.

Must be an experienced manager of people and relish taking on and achieving success on challenging work in a complex company structure. 

Experience with outside regulators, governmental entities, etc.

Skills

Broad knowledge of managed care, government programs, or other product lines.

Must have strong business and managed care acumen and a demonstrable record of achieving net revenue results throughout their career. 

A strategic thinker and good planner will be essential, along with someone who can communicate well and motivate others. 

Proven execution against aggressive objectives. 

Strong organizational leadership, administration, analytical, negotiation and financial management skills. 

Excellent communication, written, oral and interpersonal. 

Ability to develop and maintain strong business relationships.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information