Director, Medicaid Programs- JHP

Jefferson Health Plans • Philadelphia, PA

27d • Hybrid

About The Position

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.

Requirements

• 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.
• Education: Bachelor’s degree in law, Public Health, Healthcare Administration, or related field; advanced degree or JD preferred.
• 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.

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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 501-1,000 employees