Director 2, Medicaid Services
About The Position
Provides executive-level leadership, strategic direction, and oversight of the district’s Medicaid programs, including School Health and Related Services (SHARS), Medicaid Administrative Claiming (MAC), and Random Moment Time Study (RMTS). Serves as the district’s subject matter expert on Medicaid reimbursement strategy, compliance, and optimization. Drives revenue maximization, operational excellence, and cross-functional alignment with Special Education, Finance, Compliance, and external partners. Leads the development and execution of long-term strategies to expand Medicaid and other enterprise fund revenue, ensure regulatory compliance, enhance systems and processes, and improve service delivery impacting student outcomes. Oversees program integrity, audit readiness, and risk mitigation while building organizational capacity through leadership, training, and performance management.
Requirements
- Bachelor's Degree
- 5 to 7 years of work experience
- Advanced knowledge of Medicaid programs (SHARS, MAC, RMTS)
- Experience with eSHARS, IEP systems, financial systems, and data analytics tools
- Proficiency in Microsoft Office Suite and data visualization tools
Responsibilities
- Provides strategic leadership and direction for all Medicaid programs (SHARS, MAC, RMTS), ensuring alignment with district priorities, financial goals, and regulatory requirements.
- Develops and executes a comprehensive Medicaid revenue strategy, including forecasting, optimization initiatives, and expansion of reimbursable services.
- Oversees district-wide compliance with federal and state Medicaid regulations, IDEA requirements, and audit standards; leads all audit responses, corrective action plans, and monitoring systems.
- Serves as the primary liaison with state agencies, third-party administrators, auditors, and consultants to ensure program integrity and maximize reimbursement opportunities.
- Leads cross-functional collaboration with Special Education, Finance, IT, Compliance, and campus leadership to ensure accurate documentation, service delivery, and billing practices.
- Establishes and monitors key performance indicators (KPIs) and dashboards to track Medicaid claiming effectiveness, compliance, and revenue performance.
- Directs the design, implementation, and continuous improvement of systems and processes (e.g., eSHARS, RMTS, IEP systems) to enhance efficiency, accuracy, and scalability.
- Oversees training strategy and execution for clinicians, campus staff, and administrators to ensure high-quality documentation and compliance with Medicaid requirements.
- Leads data analysis efforts to identify trends, gaps, and opportunities for improved claiming, service delivery, and financial performance.
- Manages and develops a team of managers and professional staff, establishing clear expectations, accountability structures, and succession planning.
- Develops and manages the Medicaid program budget, including vendor contracts, cost allocation, and return-on-investment analysis.
- Advises executive leadership on Medicaid-related risks, opportunities, and policy changes; provides recommendations to inform strategic decisions.
- Oversees customer service and stakeholder engagement strategies to ensure strong partnerships with campuses, departments, and external entities.
- Leads special projects and initiatives related to Medicaid, healthcare funding, special education (IEP) management systems, and integrated service delivery models.
- Other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Number of Employees
5,001-10,000 employees
