Executive Director, Medicaid ACO

RHC Group Management LLC•Westwood, MA

1d•$175,000 - $225,000

About The Position

This Executive Director, Medicaid ACO supports our mission through owning the strategy, P&L performance, and multi-market growth of the organization’s Medicaid ACO business unit. This leader sets the vision and executes a comprehensive operating plan that delivers financial discipline, quality outcomes, and member experience—while building strong external partnerships and ensuring full regulatory compliance.

Requirements

Progressive leadership experience overseeing complex risk‑based programs with direct financial accountability and multimarket scale.
Demonstrated success driving program performance through cross functional execution, data‑driven decision making, and portfolio optimization of risk arrangements.
Deep familiarity with Medicaid managed care/ACO operations, MassHealth or comparable state programs, network development, and regulatory engagement.

Responsibilities

Own full P&L for the Medicaid ACO business unit; develop the annual budget and strategic plan, track, key drivers and KPIs, and adjust initiatives to meet aggressive margin and utilization targets.
Lead monthly performance reviews that surface risks/opportunities and present mitigation plans to executive leadership.
Define and execute the national growth strategy for Medicaid risk programs, including market assessments, portfolio design of risk arrangements, and execution of new deals/expansions in coordination with regional leadership.
Spearhead high impact initiatives (care management, quality improvement, utilization management, network optimization) to achieve targets in admissions/readmissions, total cost of care, and member experience.
Lead Medicaid health plan development activities (business requirements, operating model design) and partner with plan leadership to implement end-to-end functions (benefit ops, claims/data flows, reporting).
Build and maintain relationships with state regulators (e.g., Executive Office of Health and Human Services, Division of Insurance); review and approve regulatory deliverables prior to executive signoff and submission.
Represent the organization in external forums (Boards, conferences, payer/regulator meetings) and—where applicable—partner with federal stakeholders.
Use robust analytics to drive data‑informed decisions; develop models and ad hoc analyses to understand historical trends and forecast performance; translate insights into actionable programs at scale.
Communicate performance insights and complex program information clearly to internal and external stakeholders.
Ensure compliance with all Medicaid ACO Agreement requirements and applicable laws, rules, and regulations; establish internal controls and readiness for audits.
Lead governance structures for the Medicaid ACO (steering committees, leadership councils) and present to executive/board bodies as needed.
Directly supervise program leaders and distributed staff; build a high performing operations unit and foster talent development, accountability, and a culture of continuous improvement.