Talent.com
Director, Medicaid Programs- JHP

Director, Medicaid Programs- JHP

JeffersonPhiladelphia, PA, US
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
  • serp_jobs.job_card.part_time
job_description.job_card.job_description

Director Of Medicaid Programs

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.

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 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.

    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

    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.

    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.

    serp_jobs.job_alerts.create_a_job

    Program Director • Philadelphia, PA, US

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    CLINICAL PROGRAM DIRECTOR

    CLINICAL PROGRAM DIRECTOR

    Universal Health ServicesKing Of Prussia, PA, US
    serp_jobs.job_card.full_time
    One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. UHS) has built an impressive record of achievement and performance.Growi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Director of HIM / Medical Records

    Director of HIM / Medical Records

    Universal Health ServicesHorsham, PA, US
    serp_jobs.job_card.full_time
    Director Of Health Information Management Services.The Horsham Clinic is a 206-bed private behavioral healthcare facility located on a beautiful 55-acre suburban campus in Montgomery County.We are ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Director of Programs - Northeast Region

    Director of Programs - Northeast Region

    HealthCorpsPhiladelphia, PA, US
    serp_jobs.job_card.full_time
    Territory : Must reside within 25 miles of one of the following cities : Pittsburgh, PA; Cleveland, OH; Philadelphia, PA. New York, NY; Baltimore, MD.Are you a visionary leader passionate about empow...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Director, Provider Reimbursement and Contract Analysis- JHP

    Director, Provider Reimbursement and Contract Analysis- JHP

    JeffersonPhiladelphia, PA, US
    serp_jobs.job_card.full_time
    Director, Provider Reimbursement And Contract Analysis.The Director, Provider Reimbursement and Contract Analysis is responsible for developing reimbursement strategies and methodologies, network r...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Director Care Management - EIP

    Director Care Management - EIP

    Cooper University Health CareMerchantville, NJ, US
    serp_jobs.job_card.full_time
    Oversight of EIP medical and dental care, supportive care, and special project initiatives impacting medical care in collaboration with EIP Managers. Services for HIV medical care, primary care and ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Director of Health Services

    Director of Health Services

    Overbrook School for the BlindPhiladelphia, PA, US
    serp_jobs.job_card.full_time
    The Director of Health Services of Overbrook School for the Blind exudes a passion for the school, its students, and its employees. This position will report directly to the Superintendent.The Missi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Director of Crisis Intervention Services

    Director of Crisis Intervention Services

    Access ServicesLafayette Hill, PA, US
    serp_jobs.job_card.full_time
    Crisis Intervention Services Director.Are you a leader of behavioral health in crisis counseling, suicidal intervention, and crisis family supports? Does your passion for service express itself thr...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Clinic Director

    Clinic Director

    Forge HealthPrinceton, NJ, US
    serp_jobs.job_card.full_time
    Forge Health is a mission-driven outpatient mental health and substance use provider dedicated to providing the highest quality, affordable, and effective care to individuals, families, and communi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Clinical Program Director (RN)

    Clinical Program Director (RN)

    HealogicsSewell, NJ, US
    serp_jobs.job_card.full_time
    The rewards at Healogics are immense, starting with the important work we do to change patients' lives.We also understand that meaningful work is hard work, and we are committed to supporting and c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Program Director - Physician Services - Quality

    Program Director - Physician Services - Quality

    Universal Health Services, Inc.King of Prussia, PA, United States
    serp_jobs.job_card.full_time
    Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS.IPM develops and manages multi-specialty physician networks and urgent care cl...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Regional DirectorPhiladelphia, PA

    Regional DirectorPhiladelphia, PA

    MedelitePhiladelphia, PA, US
    serp_jobs.job_card.full_time
    Location : Pennsylvania Schedule : Full-Time; 9 : 00 am- 5 : 00 pm Salary : $110,000 - $130,000 per annum.Since 2011, MedElite has been dedicated to improving the standard of care in skilled nursing and l...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Director, CHIP Programs - JHP

    Director, CHIP Programs - JHP

    JeffersonPhiladelphia, PA, US
    serp_jobs.job_card.full_time +1
    The Director of CHIP 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.Th...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Director of HIM / Medical Records

    Director of HIM / Medical Records

    Universal Health Services, Inc.Ambler, PA, United States
    serp_jobs.job_card.full_time
    We are minutes from Philadelphia and serve patients and families from Southeastern Pennsylvania and New Jersey.The Horsham Clinic provides comprehensive behavioral health services to children, adol...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Program Director

    Program Director

    Youth Advocate ProgramsHaddon Heights, NJ, US
    serp_jobs.job_card.full_time
    Requisition Number : PROGR002615.Location : Haddon Heights, NJ 08035, USA.Pay Range : $60,000 to $70,000 USD.Summary of Position : Program Director is responsible for the overall administration of the ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Program Director

    Program Director

    BancroftMount Laurel, NJ, US
    serp_jobs.job_card.full_time
    Bancroft is a leading service-provider for children and adults with autism, other intellectual or developmental disabilities or those in need of neurological rehabilitation.We provide a full contin...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Program Director

    Program Director

    SevitaMount Laurel, NJ, US
    serp_jobs.job_card.full_time +1
    Program Director, Idd Services.Location : Oversees Operations of 3-4 Group Homes in Burlington / Camden / Gloucester Counties. Have you been looking for a fantastic role to continue your career path in S...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Director Health Tech Cardiopulmonary

    Director Health Tech Cardiopulmonary

    J&J Family of CompaniesSpring House, PA, US
    serp_jobs.job_card.full_time
    Director Health Tech- Cardiopulmonary.Johnson & Johnson, is recruiting for a Director Health Tech- Cardiopulmonary with dual strengths in strategic foresight and operational delivery to be located ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Associate Medical Director, Primary Care

    Associate Medical Director, Primary Care

    Capital HealthTrenton, NJ, US
    serp_jobs.job_card.full_time +2
    Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology.Capi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30