SVP, Health Plan - CA Market

Overview

Job Summary 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). This role requires strong communication, adaptability, and the ability to build consensus in a complex, matrixed environment. The SVP partners closely with Regional Presidents (RP), Executive Medical Directors (EMDs), and national function leaders to drive membership growth, revenue, and margin sustainability.

• Partnership with Regional President(s) and Executive Medical Director(s):
  Collaborate with regional president(s) and Executive Medical Director(s) to align and lead operations and initiatives to achieve market leading growth and total margin.
• Strategic Planning & Alignment:
  Partner with Regional Presidents (RP) and Executive Medical Directors (EMDs) 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.
• Performance & Growth Management:
  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.
• Rate Setting & Underwriting:
  Partner with RP to lead rate setting and partner with underwriting and actuarial teams to ensure competitive pricing, revenue sufficiency, and regulatory compliance.
• Network Management:
  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.
• Medical Cost Trend Management:
  Partner with the national function leaders and regional president and seek consultation of EMD to support analytic and contracting strategies to control medical cost trends while maintaining quality of care and member satisfaction.
• Drive local market accurate and comprehensive diagnostic coding:
  Collaborate 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.
• Customer & Broker Relationships:
  Foster strong relationships to improve retention, satisfaction, and market presence.
• Go-to-Market & Sales Leadership:
  Partner with marketing and sales teams to develop and execute local market strategies for brand awareness, member acquisition, and retention.
• Line of Business Leadership:
  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.
• Commercial Lines of Business:
  Drive financial and operational performance across commercial product lines, including individual. Set competitive rates and benefits to support growth and market needs. Partners to ensure network adequacy, compliance, and member satisfaction. Partner to support affordability action plans and analyze medical spending.
• Medicare Line of Business:
  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. Work with key leaders to support the success of the Medicare Stars program, inclusive of action plans aimed at achieving high MCAHPS and NPS.
• Medicaid Line of Business:
  Partner to ensure effective population health programs and support affordability action plans. Partners to ensure compliance with CMS and state regulations. Partner for network adequacy and member satisfaction through collaborative action plans aimed at achieving…