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Jefferson Health · 15 hours ago

Director, Medicaid Programs- JHP

Philadelphia, PA

Full-time

Onsite

Director/Executive

7+ years exp

Jefferson Health is a nationally ranked healthcare system dedicated to providing compassionate clinical care. The Director of Medicaid Programs is responsible for leading the company’s Medicaid policy strategy, ensuring compliance with regulations while driving growth and innovation in the Medicaid line of business.

Hospital & Health Care

Responsibilities

Develop and execute comprehensive policy and regulatory strategies to both ensure full compliance with Medicaid program requirements and advance long-term growth and sustainability goals for the Medicaid line of business

Identify opportunities for enrollment growth, improved quality performance, and integration with provider system initiatives

Use market intelligence and policy insights to anticipate changes in the Medicaid landscape and position the plan for long-term success

Implement strong project management and governance structure to drive forward cross-functional tactics that will position the Medicaid line of business for long-term success

Develop and maintain an actionable, measurable ongoing annual strategy for growth and retention of Medicaid members, working collaboratively to translate policy ideas into operational implementation

Conduct in-depth analysis of state and federal Medicaid policy trends, funding mechanisms, and program reforms

Advise executive leadership on strategic implications of regulatory developments, including potential impacts on rates, benefits, eligibility, and enrollment

Align Medicaid policy strategy, where appropriate, with the parent delivery system’s goals and value-based care initiatives

Collaborate with legal, compliance, and operational teams to mitigate regulatory risk and address findings

Monitor regulatory developments at CMS, state Medicaid agencies, the Centers for Medicare & Medicaid Services, and the Department of Health and Human Services that impact these programs

Maintain Oversight of policy and regulatory intelligence and key regulatory communications including risk assessment governance

Implement direct end-to-end contract and program administration including review and approval of marketing materials and mandated member communications

Lead regulatory submissions for the Medicaid line of business

Collaborate with product development, actuarial, legal, and compliance teams to align regulatory requirements with benefit design and operations

Serve as the primary liaison with state regulators, representing the plan in collaboration with the Chief Growth Officer in policy discussions, rate-setting processes, and contract negotiations

Represent Jefferson Health Plans in all state and federal associations and partnerships

Build strong relationships with state officials, community-based organizations, and other external stakeholder groups that impact the Medicaid line of business

Represent the plan as needed at industry forums, workgroups, and coalitions related to Medicaid health coverage

Serve as the primary point of contact for federal and state regulatory agencies regarding Medicaid policy and regulatory issues

Qualification

Medicaid policy strategyRegulatory complianceRegulatory affairs experienceStakeholder engagementProject managementStrategic mindsetLeadership skillsCommunication skillsDetail-orientedOrganizational skills

Required

Bachelor's degree in law, Public Health, Healthcare Administration, or related field

7+ years of regulatory affairs experience, specifically with Medicaid programs

Strong knowledge of CMS regulations, Medicaid managed care rules, and state program guidelines

Demonstrated experience managing complex regulatory filings and compliance programs for government health plans

Ability to interpret and apply complex regulatory guidance to business operations and product offerings

Excellent communication and leadership skills with the ability to influence cross-functional teams

Experience working with federal and state regulators

Detail-oriented with strong organizational and project management skills

Experience with Medicaid managed care plans or state government

Familiarity with state Medicaid waiver and procurement processes and program implementation

Strategic mindset with ability to anticipate regulatory changes and drive proactive solutions

Preferred

Advanced degree or JD preferred

Benefits

Medical (including prescription)

Supplemental insurance

Dental

Vision

Life and AD&D insurance

Short- and long-term disability

Flexible spending accounts

Retirement plans

Tuition assistance

Voluntary benefits

Company

Jefferson Health

Thomas Jefferson University and Thomas Jefferson University Hospitals are partners in providing excellent clinical and compassionate care for our patients in the Philadelphia region, educating the health professionals of tomorrow in a variety of disciplines and discovering new knowledge that will define the future of clinical care.

Founded in 1995

Philadelphia, PA, US

5001-10000 employees