Assistant Director of Medicaid & Integrated Products

Product Strategy and Innovation

• Serves as Medicaid Product SME to internal operational, technical, regulatory, clinical, and other cross-functional teams to support the exploration, coordination, and implementation of new Medicaid products, service area changes, and/or benefit designs, DOH and/or CMS required regulations, and/or strategic improvement initiatives.
• Evaluates, develops, and builds new offerings within Medicaid and integrated benefits program including liaising with cross-functional stakeholders and government agencies on regulatory submissions, regulatory communications, readiness reviews, and overall product build & ongoing implementation. 
• Develops and leads systematic competitive intelligence monitoring and tracking such as benefit design and vendor utilization, product/plan offerings, membership and enrollment trends, service area modifications, mergers and acquisitions, and marketing and promotion efforts. 
• Conduct in-depth research on business and market trends, product analyses, and competitive intelligence to leadership teams for strategy development.

Federal and State Regulatory and Policy Analysis & Oversight  

• Monitor and track Federal and State policies & regulations that impact Medicaid and integrated benefit products across contractual obligations, eligibility, enrollment, marketing, benefits offering, utilization management, and other areas.
• Analyze and interpret CMS and State contractual requirements and updates across all products (e.g., model contracts, state Medicaid agency contract)
• Assess and evaluate Federal and State regulatory and policy impacts on products’ growth and operations, and summarize risks or opportunities with business stakeholders in plan-wide forums.
• Support internal leadership and external audiences (e.g., government agencies, association groups) in defining advocacy points, recommendations or suggestions in response to proposed regulations or policies, and coordinate responses to the State on behalf of the organization
• Lead and/or support Medicaid, Managed Long-Term Care, and Integrated Product regulatory reporting
• Reviews member communications and coordinate with internal teams to ensure regulatory compliance and implementation according to Medicaid managed care requirements.

Product Analytics and Optimization 

• Partners with internal departments to ideate and evaluate product metrics (enrollment, disenrollment, Medicaid recertification, member experience and interaction, benefit utilization, demographics, risk scores, and others) to support ongoing product performance and identify areas of opportunity.
• Identifies member and provider abrasion points based on product offerings, and proactively initiates cross-functional projects to improve member and provider experience, workflows, or marketing awareness.
• Proactively initiates and leads projects to support member growth and retention including developing business case and scope, defining project parameters, implementation requirements (operational and technical), and evaluation metrics to evaluate success.

Support Organization and Departmental goals

• Tracks overall Product Initiatives Dashboard to monitor team capacity, resource tracking, and overall progress towards company and departmental goals.
• Collaborates with Director to support product changes, strategic performance improvement initiatives, regulatory compliance and auditing, policy & procedure development, and ongoing management of product operations.
• Coordinates all phases of a project lifecycle including but not limited to initiation, project plan development and management, execution, control and quality assurance management, post-implementation monitoring, overall project documentation, and project close out and hand-off.
• Represent Elderplan/HomeFirst and Medicaid & Integrated Products team in government agency meetings, or external meetings with providers and advocates.
• Completes adhoc tasks and assignments as requested.

• Utilizes corporate services resources such as Human Resources, Compliance, Legal, Finance, Information Services, Marketing, etc., as appropriate.
• Interviews and participates in the selection process for qualified staff in collaboration with Human Resources and department management.

• Bachelor’s degree required. Graduate degree in business, health administration, public policy or related area preferred.
• Minimum of five years of heath plan experience is required, with core experience in Medicaid Managed Care and in any of the following disciplines: Product development & management, Quality, Clinical Strategy & Operations (UM/CM), Health Economics, Finance, Health Plan Operations, or health care industry/healthcare consulting.
• Minimum of 2-3 years of managerial experience.
• Requires in-depth knowledge of Medicaid Managed Care program, preferably in the New York market, and CMS/State regulations across key areas such as benefit offerings, eligibility and enrollment, quality, utilization management, care management, regulatory and compliance, finance and health economics.
• Demonstrated ability to initiate, plan, implement, and project manage high-visibility, cross-functional initiatives to successful completion.
• Requires ability to read complex statutes and regulations and interpretation to identify operational, financial, or regulatory risk.
• Strong and proactive work ethic, attention to detail, effective time management, and commitment to developing quality work quickly.
• Can critically interpret and synthesize key data for leadership and business stakeholders to inform and influence decision-making.
• Strong public speaking and oral and written communication skills.
• Advanced Microsoft Word, PowerPoint, Excel skills.