Chief Executive Officer

Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.

POSITION SUMMARY

The Chief Executive Officer (CEO) will lead Gold Coast Health Plan, ensuring the delivery of high-quality, equitable, and cost-effective healthcare services to Medi-Cal beneficiaries. Reporting directly to the Ventura County Medi-Cal Managed Care Commission (Commission), the CEO will be accountable for strategic vision, operational excellence, financial sustainability, and adherence to all state and federal Medicaid regulations. This role requires a dynamic and experienced leader with deep knowledge of managed care operations, Medicaid policy, and ideally, healthcare delivery systems in California. The CEO must embody a mission-driven, member-focused approach and lead with integrity and collaboration. 

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodations, each essential function satisfactorily. The requirements listed below as essential functions represent the knowledge, skill, or ability required for this position. Reasonable accommodations that do not cause an undue hardship may be made for individuals with disabilities.

Strategic 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.
• Anticipate and respond to emerging trends in healthcare, including policy changes, technological advancements, and population health initiatives, ensuring the organization remains innovative and forward-thinking.
• Serve as a visible and trusted leader, representing the organization at public forums, community events, industry conferences, and policy discussions.

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.
• Foster a culture of operational efficiency, continuous improvement, and data-driven decision-making.
• Oversee the development and maintenance of robust IT systems and infrastructure to support efficient operations, compliance, and reporting.

Financial Stewardship

• 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.
• Cultivate a culture of innovation, continuous improvement, and excellence while maintaining a deep commitment to ethical leadership and accountability.

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.
• Notify the Commission in advance of any planned changes, such as executive staff appointments, organizational restructuring, or modifications to the salary schedule, ensuring transparency and alignment with organizational goals.
• Monitor and inform the Commission of legislative and regulatory changes, as well as requirements from government agencies and accrediting bodies, that impact the Plan’s facilities, services, and programs.
• Maintain effective liaison with government agencies and accrediting bodies, ensuring compliance with all applicable standards and implementing necessary actions to uphold accreditation and regulatory requirements.
• Manage the hiring and termination of personnel in accordance with Plan employment policies, subject to the oversight and discretion of the Commission.
• Serve as the administrator for all contracts involving the Plan, ensuring proper execution, compliance, and oversight.
• Provide the Commission and its Committees with sufficient staff support to enable informed decision-making and effective governance.
• Submit periodic reports to the Commission detailing the Plan’s overall activities, financial performance, and financial position, as well as significant federal, state, and local developments impacting operations.
• Ensure adequate insurance or self-insurance coverage for the Plan’s physical assets and activities to mitigate risks and protect organizational resources.
• Develop, revise, implement, and enforce personnel policies that align with the Plan’s operational needs and strategic objectives.
• Undertake additional projects and responsibilities as assigned by the Commission or its Committees.

SKILLS & ABILITIES

Education

• 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.
• Proven expertise in advocacy, policy development, and organizational representation, with extensive experience engaging and collaborating with regulatory agencies.
• Track record of success in implementing delivery system reforms focused on promoting health equity and improving outcomes for underserved populations.
• Recent experience leading organizational transformation and driving large-scale, strategic change initiatives.
• Proven ability to deliver impactful presentations. 

Preferred Experience

• CEO experience with Medi-Cal and/or government-sponsored healthcare programs, as well as familiarity with related public policy.
• Experience managing a Dual-Eligible Special Needs Plan (D-SNPs), including compliance with Medicare Advantage requirements and integration with Medicaid services. 
• Experience operating a public agency, working with a governing board or Commission; knowledge of Brown Act, Public Records Act and other public agency regulatory requirements.

Skills and Competencies

• Strategic thinking with the ability to translate vision into actionable plans.
• Exceptional communication and relationship-building skills, with the ability to engage diverse stakeholders effectively.
• Strong financial acumen, including knowledge of Medicaid funding, risk adjustment, and value-based payment models.
• Expertise in navigating complex regulatory environments and ensuring organizational compliance.
• Commitment to innovation, equity, and the delivery of member-centered care.

LICENSES

       All licenses and certificates must be maintained as a condition of employment.

• Possession of, or ability to obtain, a valid appropriate California driver's license.
• Maintain a satisfactory driving record.

WORK SCHEDULE

Travel; work protracted and irregular hours and evening meetings, or work unusual hours for meeting attendance or participation in specific projects or programs.

PHYSICAL DEMANDS

N (Not Applicable)               Activity is not applicable to this position.

O (Occasionally)                   Position requires this activity up to 33% of the time (0 - 2.5+ hrs/day)

F (Frequently)                       Position requires this activity from 33% - 66% of the time (2.5 - 5.5+ hrs/day)

C (Constantly)                       Position requires this activity more than 66% of the time (5.5+ hrs/day)

Other Physical Requirements

• Vision (Near, Distance, Color, Peripheral, Depth)
• Speech and hearing sufficient to communicate and lead

WORK ENVIRONMENT

The work environment described here is generally representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations that do not cause an undue hardship may be made for individuals with disabilities to perform the essential functions.