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Thomas Jefferson University · 3 months ago

Director, Medicaid Programs- JHP

Philadelphia, PA

Full-time

Hybrid

Director/Executive

7+ years exp

Thomas Jefferson University is seeking a Director of Medicaid Programs to lead regulatory and policy strategy in a complex healthcare landscape. This senior leadership role involves ensuring compliance with Medicaid requirements while driving growth and innovation in the Medicaid line of business.

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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 affairs experienceCMS regulations knowledgeStakeholder engagementProject management skillsLeadership skillsCommunication skillsDetail-orientedOrganizational skills