Regional Vice President (Clark County, NV)

Overview of the Role:

Reporting to the SVP East Coast Region, the Regional Vice President/General Manager (RVP/GM) role is a critical leadership position responsible for driving market performance and achieving operational excellence in Nevada. The primary focus of this role is to hit key metrics, including achieving an 85% Medical Loss Ratio (MLR), ensuring MRA quality, driving a minimum of 30% net membership growth annually, and reaching 85% compliance in JSA and Annual Wellness Visits (AWVs).

The RVP/GM will manage end-to-end market performance, including overseeing P&L performance, market planning, and execution, while fostering effective relationships with key stakeholders across the healthcare ecosystem. To hit key metrics, the RVP/GM must drive collaboration and hold stakeholders accountable (internal and external). For example, leading the Health Economics team in designing and developing reporting to support Provider Contracting and Network Development, analysis of product line profitability, gross margin, and expansion market analytics.

Responsibilities:

P&L Management: Develop and execute the P&L strategy for Nevada and expansion markets, ensuring financial targets and MLR of 85% are met or exceeded. Develop and operationalize predictive KPI’s to better forecast and manage responsible markets.
Operational Excellence: Drive performance in CAHPS, HEDIS, and HOS measures, aiming for 4 STARs or higher, and ensure efficient management of JSA’s and AWV’s to hit 85% completion rates.
Quality and Compliance: Lead initiatives to improve MRA quality and coding accuracy, maintaining compliance with CMS regulations, and hitting targets for quality programs.
Stakeholder Engagement: Build and maintain strong relationships with physician leaders, health systems, IPAs, and community partners to enhance market performance and strategic alignment.
Sales and Membership Growth: Direct local sales teams through market leaders to achieve a minimum of 30% net membership growth annually, aligned with market goals and regulatory requirements with a push with aligned quality partners.
Performance Management: Conduct quarterly business reviews through developed scorecards from provider operations, assess performance metrics, and implement corrective actions to drive improvements across key performance indicators. Work with Health Economics and Contracting teams to analyze contract rate trending impact and anomalies.
Market Strategy: Develop and refine business plans for Northern California and Nevada, incorporating regulatory impacts and changes to support sustainable plan performance.
Health Plan Oversight: Collaborate with Medical Officers and other departments to manage IPA, medical group, and hospital performance, with a focus on achieving budget and operating goals.
Utilization and Cost Management: Monitor regional performance, implement standardized performance scorecards, …