PriMed/Hill Physicians Medical Group has retained Morgan Consulting Resources to conduct a search for the Vice President of Government Programs and Full Risk Business. This is an outstanding opportunity to be an integral member of a dynamic and growing organization. This position can be based in San Ramon or Sacramento, CA with an opportunity for a hybrid work schedule of at least two days a week in the office.

About the Company:

Hill Physicians was organized over 40 years ago and has become the largest Independent Physician Groups (IPA) in California with over 6,000 physicians working in over 3,200 offices throughout Northern California. Currently, Hill Physicians cares for approximately 300,000 HMO members through multiple health plans. In addition, in recent years, they have aggressively and successfully broadened their clinical outreach and now also provide care management services for approximately 120,000 attributed PPO patients. Collectively, Hill Physicians’ doctors care for approximately 420,000 patients.

PriMed is the management services organization (MSO) that organized Hill Physicians in 1984 and, in serving as its MSO, has played a key role in Hill Physicians’ success. PriMed currently employs a staff of over 675 to provide management and administrative support to Hill Physicians. Since 1984, continuity of management and consistently successful execution have created the respect and trust required for healthy inter-dependence between physicians and management.

For more information about PriMed/Hill Physicians Medical Group please visit: www.hillphysicians.com.

About the Position:

Reporting to the Chief Financial Officer (CFO), the Vice President, Government Programs and Full Risk Business will oversee the Government Programs operations and manage the Full Risk business with an annual operating revenue of over $150 million. The VP, Government Programs and Full Risk Business will develop and implement comprehensive strategies for the Government Programs department and the Full Risk Business Unit to meet evolving market demands and position the company for growth while ensuring compliance with all federal and state regulations.

We are looking for an experienced and strategic leader who will drive the growth and success of the Medicare Advantage, MediCal, ACA, and Full Risk lines of business. Hill Physicians launched their Medicare Advantage full risk business in 2020 and currently serves 14,000 members. Under the full risk arrangement, they assume Medicare Advantage full risk by accepting both institutional and professional risk-based capitation payments.

Select Responsibilities:

• Oversee the financial performance of the Medicare Advantage, MediCal, and Affordable Care Act (ACA) programs including risk adjustment/coding accuracy, provider incentive program, and vendor management.
• Oversee the full risk business unit P&L to make sure that it meets its financial objectives. Develop financial reports and analyses to drive performance improvement, maximize revenue, and effective management of budget and cost.
• Lead cross-functional teams in a matrixed organization, fostering collaboration among departments such as clinical management, utilization management, quality management, and financial analysis to achieve corporate goals.
• Build and maintain robust relationships with health plan executives, internal stakeholders, and external partners to enhance collaboration, data exchange, and performance improvement strategies.
• Define key performance indicators (KPIs) and develop monitoring systems to assess the effectiveness of programs and operations in real-time. Utilize data analytics to drive decision-making and proactively address performance issues.
• Direct the day-to-day operations of the Full Risk and Government Programs teams, ensuring all deliverables are met while coordinating necessary activities to support the organization's strategic goals.
• Ensure adherence to CMS regulations and DMHC requirements, working closely with legal and compliance teams to mitigate risks and ensure operational integrity.

Qualifications & Experience:

• Bachelor’s degree in business administration, healthcare administration, or related field required. An advanced degree is preferred.
• 10+ years of progressive experience in a managed care or healthcare organization, with significant operational and strategic leadership experience.
• Significant operations and Medicare/MediCal/ACA program experience and full risk business management experience.
• In-depth understanding of managed care operations, Medicare Advantage, MediCal programs, and financial management within the healthcare industry.
• Familiarity with regulatory compliance and industry trends is crucial.

Salary range: $235k-$250k + bonus potential.

To further explore this opportunity, express interest, or share referrals, please contact Amy Jones:

Amy Jones, Senior Executive Search Consultant
Morgan Consulting Resources, Inc. ~ Healthcare Executive Search
amy@morganconsulting.com


POSITION DESCRIPTION

Job Title: Vice President of Government Programs and Full Risk Business
Location: San Ramon/Sacramento

Overview:

PriMed/Hill Physicians Medical Group seeking an experienced and strategic leader for the position of Vice President of Government Programs and Global/Full Risk Business. This role is pivotal in overseeing the Government Programs operations and managing the full risk business with an annual operating revenue of more than $150 million. The ideal candidate will drive the growth and success of our Medicare Advantage, MediCal, Affordable Care Act (ACA), and Full Risk lines of business, enhancing our service offerings while ensuring we meet financial and operations objectives.

Hill Physicians launched our Medicare Advantage full risk business in 2020 under our Restricted Knox-Keene licensed entity, Hill Physicians Care Solutions (HPCS). Under our full risk arrangement, we assume Medicare Advantage full risk by accepting both institutional and professional risk-based capitation payments.

Key Responsibilities:

Strategic Oversight: Develop and implement comprehensive strategies for Government Programs department and the Full Risk Business Unit to meet evolving market demands and position the company for growth while ensuring compliance with all federal and state regulations.

Financial Management: Oversee the financial performance of the Medicare Advantage, MediCal, and Affordable Care Act (ACA) programs including risk adjustment/coding accuracy, provider incentive program, and vendor management. Oversee over the full risk business unit P&L to make sure that it meets its financial objectives. Develop financial reports and analyses to drive performance improvement, maximize revenue, effectively management of budget and cost.

Cross-Functional Leadership: Lead cross-functional teams in a matrix organization, fostering collaboration among departments such as clinical management, utilization management, quality management, and financial analysis to achieve corporate goals.

Stakeholder Engagement: Build and maintain robust relationships with health plan executives, internal stakeholders, and external partners to enhance collaboration, data exchange, and performance improvement strategies.

Performance Monitoring: Define key performance indicators (KPIs) and develop monitoring systems to assess the effectiveness of programs and operations in real-time. Utilize data analytics to drive decision-making and proactively address performance issues.

Operational Excellence: Direct the day-to-day operations of the Full Risk and Government Programs teams, ensuring all deliverables are met while coordinating necessary activities to support the organization's strategic goals. Responsible for department staffing, training, and development.

Program Development: Oversee the design, planning, and execution of cross-functional programs and projects that align with corporate strategies and contribute to overall business objectives.

Regulatory Compliance: Ensure adherence to CMS regulations and DMHC requirements, working closely with legal and compliance teams to mitigate risks and ensure operational integrity.

Reporting and Communication: Regularly report to senior management on the status of Government Programs and Full Risk Operations, presenting analyses, recommendations, and performance outcomes in both internal and external forums.

Required Qualifications:

Education: Bachelor’s degree in business administration, healthcare administration, or related field required. An advanced degree is preferred.

Experience: 10+ years of progressive experience in a managed care or healthcare organization, with significant operational and strategic leadership experience, with significant operations and Medicare/MediCal/ACA program experience and full risk business management experience.

Skills:

• Exceptional analytical skills for deriving insights from complex data.
• Proven leadership ability to influence and mobilize cross-functional teams.
• Strong presentation, written, and verbal communication skills, with proficiency in tools such as PowerPoint and Excel.
• Demonstrated capability in change management, problem-solving, and strategic planning.

Knowledge: In-depth understanding of managed care operations, Medicare Advantage, MediCal programs, and financial management within the healthcare industry. Significant full risk business unit management experience. Familiarity with regulatory compliance and industry trends is crucial.

What We Offer:

- Competitive salary and benefits package

- Opportunities for professional growth and advancement

- A dynamic and collaborative work environment

If you are a results-oriented leader with a passion for improving healthcare services and outcomes, we invite you to apply for this critical role.

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