Chief Executive Officer

Company: ASSOCIATION FOR COMMUNITY AFFILIATED PLANS
Location: Washington
Posted on: January 28, 2025

Job Description:

Morgan Consulting Resources, Inc. has been retained to conduct the search for the Chief Executive Officer for Gold Coast Health Plan. This is a unique opportunity to lead with purpose and make a transformative impact on the health and well-being of Ventura County residents. The ideal leader will bring a combination of expertise, empathy, and vision to guide the organization through challenges and into a future of innovation and excellence. The position is located in Camarillo, CA.About the organization:Gold Coast Health Plan proudly serves Medi-Cal beneficiaries living in Ventura County, California. We are an independent public entity governed by the Ventura County Medi-Cal Managed Care Commission and are dedicated to serving our members. The Commission is comprised of locally elected officials, providers, hospitals, clinics, the county health care agency and consumer advocates. Our member-first focus centers on the delivery of exceptional service to our beneficiaries by enhancing the quality of health care, providing greater access and improving member choice.Gold Coast Health Plan is committed to making a difference in the communities we serve. Through grants, sponsorships and the fundraising efforts of our employees, we support the organizations that are making a difference in the lives of Ventura County's Medi-Cal members. Our goal is to fulfill our vision of compassionate care, accessible to all, for a healthy community. Gold Coast Health Plan delivers healthcare services with a member-first focus that reflects a commitment to our members and our providers. We understand the necessity of having a local presence in the cities we serve, and we are committed to establishing and strengthening relationships in those communities.Mission: To improve the health of our members, through the provision of high quality care and services.About the position:The CEO is a pivotal leadership role dedicated to improving health outcomes for Medi-Cal beneficiaries in Ventura County. In addition, the CEO will play a key role in launching Gold Coast's D-SNP plan, offering a unique opportunity to transform healthcare for individuals eligible for both Medicare and Medicaid in the county. The CEO will act as the visionary and operational steward, navigating the complexities of California's Medi-Cal system while fostering innovation and collaboration. This role requires a leader who can align strategic objectives with practical execution, ensuring both operational efficiency and the equitable delivery of healthcare services to vulnerable populations.The CEO will drive the organization's strategic vision to improve health outcomes, address health disparities, and enhance member satisfaction. The CEO will oversee operational functions, including enrollment, provider network management, claims processing, quality improvement, and the integration of the D-SNP plan. Financial stewardship will also be central to the role, as the CEO ensures fiscal sustainability through strategic budgeting, revenue management, and cost-effective partnerships with healthcare providers.As the primary liaison to the Ventura County Medi-Cal Managed Care Commission, the CEO will maintain transparent communication and ensure the organization adheres to state and federal Medicaid regulations. Moreover, the CEO will cultivate a high-performing executive team, prioritize diversity and equity, and foster a mission-driven culture that aligns with the organization's goals of addressing health inequities and improving care for underserved communities.What success looks like:Success in this role means leading Gold Coast Health Plan to achieve measurable improvements in access to care, member satisfaction, and health equity. The CEO will be recognized as a trusted advocate in the community for Medi-Cal beneficiaries and a transformative leader who inspires management and team members across the organization. By embodying a member-first approach and demonstrating servant leadership, the CEO will leave a lasting impact on the health and well-being of Ventura County's most vulnerable residents.Essential FunctionsStrategic Leadership

• Develop and implement the organization's strategic vision and long-term goals in alignment with California's Medicaid program (Medi-Cal) priorities, focusing on improving health outcomes, addressing health disparities, and enhancing member satisfaction.
• Drive strategy and innovation for D-SNP programs, ensuring they meet the unique needs of dual-eligible (Medicare and Medicaid) beneficiaries while maintaining compliance with CMS and state requirements.
• Build and maintain strong relationships with stakeholders, including state regulators (e.g., California Department of Health Care Services & California Department of Managed Health Care), CMS, healthcare providers, advocacy groups, and community organizations.Operational Oversight
• Provide executive leadership for all operational functions, including enrollment, provider network management, claims administration, utilization management, quality improvement, and member services.
• Oversee the successful operation and integration of D-SNP plan, ensuring alignment with both Medicare and Medicaid program requirements.
• Ensure the organization meets key performance indicators (KPIs) related to access, quality, cost, and member experience.
• Develop and manage the organization's annual operating budget, ensuring financial sustainability while maximizing resources for member care.
• Monitor financial performance, including revenue cycle management, risk adjustment, medical loss ratios (MLR), and D-SNP profitability, taking corrective actions as needed.
• Negotiate and oversee contracts with healthcare providers, vendors, and other key partners to ensure cost-effective service delivery.
• Pursue innovative payment models and value-based care arrangements to improve cost management and health outcomes.Regulatory Compliance and Governance
• Ensure compliance with all federal and state Medicaid regulations, including CMS guidelines, California's Medi-Cal managed care requirements, and D-SNP operational requirements.
• Maintain compliance with Medicare Advantage requirements specific to D-SNP, including care coordination and data reporting mandates.
• Collaborate with Commissioners to maintain effective governance practices, provide regular updates on organizational performance, and implement Commissioner directives.
• Oversee the preparation of required reports, audits, and certifications for regulatory bodies and funding entities.Team Leadership and Organizational Development
• Recruit, develop, and retain a high-performing executive leadership team, fostering a culture of accountability, collaboration, and innovation.
• Champion diversity, equity, and inclusion (DEI) initiatives within the organization and among external partners.
• Promote employee engagement, professional development, and a member-focused organizational culture.Leadership Style and Mission-Driven Approach
• Demonstrate a servant leadership style, prioritizing the needs of members, employees, and community stakeholders while fostering collaboration and trust.
• Lead with authenticity, compassion, and transparency, inspiring confidence and engagement across all levels of the organization.
• Embody the mission of delivering equitable, high-quality care to vulnerable populations, ensuring decisions align with the organization's purpose and values.
• Advocate for health equity, addressing social determinants of health and driving initiatives that reduce disparities and improve outcomes for underserved communities.Commission Relationship & Responsibilities
• Formulate and present policy recommendations for Commission review by providing expert guidance and maintaining clear, consistent communication with Commissioners. Act as the primary liaison between the Commission and staff, ensuring seamless coordination.
• Support Commission operations and administration by preparing timely, well-structured meeting agendas that align with key issues, opportunities, and strategic priorities.
• Oversee the activities of the Clerk of the Commission, ensure effective documentation and recordkeeping, and provide comprehensive written reports for all Commission meetings.
• Maintain regular communication with the Commission, deliver updates on critical matters, including grievances, significant financial developments affecting the budget, progress on major projects, and other key issues.Skills & AbilitiesEducation: Bachelor's degree in healthcare administration, business, public health, or a related field required. Master's degree (e.g., MBA, MHA, MPH) strongly preferred.Required Experience
• Minimum of 10 years of senior leadership experience in Medicaid managed care, healthcare administration, or a related field.
• Extensive experience in healthcare, with a particular focus on Medicaid managed care, including a comprehensive understanding of managed care operations such as provider contracting, claims administration, fiscal management, utilization management and quality improvement.
• Proven track record of managing large budgets, leading multidisciplinary teams, and achieving measurable improvements in operational performance and health outcomes.
• Demonstrated ability to build relationships and negotiate effectively with key stakeholders, including providers, vendors, and community-based partners, to achieve mutually beneficial outcomes.Salary Range: $393,750.00 to $656,250.00 annually.
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Keywords: ASSOCIATION FOR COMMUNITY AFFILIATED PLANS, Annandale , Chief Executive Officer, Accounting, Auditing , Washington, Virginia