Job Details
The Director of Medicaid Programs is a senior leadership role responsible for driving the company’s regulatory, policy and growth strategy across a complex and rapidly evolving healthcare landscape. This position demands a deep and comprehensive understanding of federal and state regulatory frameworks governing the Medicaid program. The Director will lead the Medicaid policy strategy to ensure the company not only meets but anticipates regulatory requirements, leverages growth opportunities and competitive positioning, and minimizes risk while enabling strategic business growth and innovation.
As a key member of the policy and regulatory affairs leadership team, the Director will influence policy interpretation, regulatory submissions, and cross-functional alignment. The Director will lead strategic development of Medicaid growth strategy and direction, driving new and innovative policy solutions that will advance growth in the Medicaid line of business. This role requires a visionary leader who can manage, mentor, and inspire a high-performing team of policy and regulatory professionals, fostering a culture of accountability, continuous learning, and proactive problem-solving. The Director will serve as the authoritative voice on Medicaid policy matters, cultivating strong relationships with regulators, industry stakeholders, and internal partners to navigate regulatory complexities effectively and strategically position the company in the marketplace.
Job Description
Strategic Leadership
- 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.
Policy Analysis & Strategy
- 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.
Government and Stakeholder Engagement
- 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.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Competencies (Knowledge, Skills, and Abilities Required):
- 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.
Minimum Education and Experience Requirements:
Education:
- Bachelor’s degree in law, Public Health, Healthcare Administration, or related field; advanced degree or JD preferred.
AND
Experience:
- 7+ years of regulatory affairs experience, specifically with and 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.
Additional Information
Please note this job description is not designed to cover or contain a comprehensive listing of
activities, duties, or responsibilities that are required of the employee for their job. Duties,
responsibilities, and activities may change at any time with or without notice.
Compliance Statement: Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign the Code of Conduct and be expected to perform their duties ethically and honestly.
#LI-Hybrid
Work Shift
Workday Day (United States of America)
Worker Sub Type
Regular
Employee Entity
Health Partners Plans, Inc.
Primary Location Address
1101 Market, Philadelphia, Pennsylvania, United States of America
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
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