Assistant Director of Medicaid & Integrated Products

Metropolitan Jewish Health System • New York, NY

6d

About The Position

The Assistant Director of Medicaid and Integrated Products is primarily responsible for guiding the planning, execution, and administration of Medicaid Managed Care, as well as supporting the MLTC & Integrated Products lines of business. Core responsibilities include assisting in the direction of product ideation, development, implementation, and continuous improvement; competitive landscape analyses and market trend monitoring in New York and regional areas; supporting the identification & development of member growth & retention strategies; leading high-visibility, cross-functional product initiatives and regulatory implementations, and overseeing the development of regulatory Medicaid member materials. The successful candidate will also co-lead Federal and State policy and regulatory analysis impacting Medicaid products, and leverage analytics to support ongoing advocacy and/or product performance monitoring.
The MJHS Difference
At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.
Benefits include:
Tuition Reimbursement for all full and part-time staff
Generous paid time off, including your birthday!
Affordable and comprehensive medical, dental and vision coverage for employee and family members
Two retirement plans! 403(b) AND Employer Paid Pension
Flexible spending
And MORE!
MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Requirements

• 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.

Responsibilities

• 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.

Benefits

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level