Senior Vice President, Government Markets

Job Description

Your Role

The Senior Vice President, Government Markets is responsible for strategic leadership, financial performance, and operational success of Blue Shield of California's government sponsored health plans, including Medicare, Individual and Family Plans (IFP), and Promise Health Plan (Medi-Cal). This executive will lead growth initiatives, ensure regulatory compliance, optimize financial performance, and cultivate key partnerships with providers, regulators, and stakeholders.

Reporting to the Executive Vice President, Chief Growth Officer, the SVP will work with other senior leaders across the enterprise to enhance BSC's market presence and deliver on its mission to provide high, quality sustainable healthcare. This role requires a visionary and results-driven leader with deep expertise in government programs, regulatory frameworks, and healthcare market dynamics. Their ability to influence, foster collaborative and strategic relationships throughout the enterprise, with key government regulators and work across the cycle of healthcare will be critical, along with a deep knowledge of the government programs around Medicare, Medi-Cal, and the Covered California healthcare exchange. This role requires a thoughtful leader who is deeply committed to the CEO's success and the achievement of Blue Shield's mission.

Responsibilities

Your Work

In this role, you will be responsible for:

Growth & Market Expansion

• Drive strategic growth and retention across Medicare, Medi-Cal, and Affordable Care Act (ACA) by identifying new market opportunities and leading expansion efforts in new geographies, product lines, and state procurements.
• Lead Blue Shield's response to government procurements and Request for Proposals (RFPs), ensuring competitive positioning and regulatory alignment.
• Develop analytics-driven strategies for membership growth, sales optimization, and targeted outreach to underserved populations.
• Create a compelling value proposition for Medicare, Medi-Cal, and IFP customers, by partnering with the product marketing team to enhance product offerings and improving quality and financial performance.

Financial & Operational Oversight

• Own P&L responsibility for government-sponsored programs, ensuring revenue maximization, accurate forecasting, and cost containment.
• Lead risk adjustment strategy team, ensuring optimal RAF score capture, encounter data submission, and compliance with CMS, DHCS, and ACA risk adjustment requirements.
• Optimize provider contract performance by driving value-based arrangements, medical cost management, and alternative payment models.
• Establish methods and structures to capture and use effective market intelligence to capitalize on emerging opportunities.

Regulatory & Compliance Leadership

• Work with compliance team to ensure full compliance with CMS, DHCS (California Medicaid), Covered California, and ACA marketplace regulations.
• Build collaborative and strategic partnerships with key government agencies, including California's Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and Covered California.
• Represent BSC in regulatory meetings, policy discussions, and industry forums, ensuring alignment with state and federal healthcare policies.
• Guide audit readiness, compliance reporting, and risk mitigation strategies related to regulatory mandates.

Provider & Network Strategy

• Establish collaborative partnerships with provider teams to drive quality, affordability, and access for government program members.
• Consult with provider and network leadership to implement value-based care models, risk-sharing arrangements, and provider incentive programs.
• Partner with clinical leadership to ensure alignment between provider strategy and care management initiatives that improve health outcomes.

Quality & Population Health Management

• Ensure alignment of Stars, HEDIS, and CAHPS initiatives with financial and regulatory goals.
• Partner with clinical and operational teams to improve quality measures, member satisfaction, and health outcomes.
• Drive population health initiatives and care management programs that align with risk-based payment models.

Qualifications

Your Required Knowledge and Experience

• Bachelor's degree required.
• 15+ years of executive leadership experience in multi-state health plan operations, government programs, or managed care organizations.
• Proven leadership in overseeing Medicare Advantage, Affordable Care Act (ACA) exchange plans, and Medicaid (Medi-Cal) programs at a regional, state, or national level.
• Led a turnaround strategy for government health programs by implementing strategic initiatives that improved financial sustainability, operational efficiency, and member experience.
• Deep expertise in regulatory compliance with Centers for Medicare & Medicaid Services (CMS), Department of Health & Human Services (HHS), state Medicaid Agencies (such as California Department of Health Care Services, DHCS, in California), and Affordable Care Act (ACA) marketplace regulations.
• Strong financial acumen and leadership experience managing Profit & Loss (P & L), capitation models, risk-sharing arrangements, and cost containment strategies.
• Executive-level collaboration with regulatory bodies, state health agencies, and key internal and external stakeholders to drive policy and operational effectiveness.
• Proven ability to drive membership growth, retention, and financial sustainability in government health programs.
• Experience managing external relationships with government agencies.

Preferred Experience

• Advanced degree ((Master of Business Administration (MBA), Master of Healthcare Administration (MHA), Master of Public Health (MPH) or related field)).
• Familiarity with population health initiatives value-based strategies and provider risk-sharing arrangements.
• Experience leading health plan expansions, responding to state/federal RFPs, or launching new-government-sponsored products and programs.
• Strong knowledge of California healthcare regulations, Medi-Cal managed care models, and ACA market dynamics.
• Experience managing relationships with California's Department of Managed Health Care (DMHC) and Covered California.

About the Team

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
  
  • Member-facing and approved out-of-state roles remain remote.
  • Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
  • For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.