Director Medicaid Programs | Chicago, IL | HCSC


This position is responsible for directing the activities related to the business operations of the Medicaid Managed Care operations in accordance with contractual and regulatory requirements. Directs the development of infrastructure, standards and policies and procedures of program changes and works with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicaid program are met, specifically around claims processing and management, . Organizes, manages, and facilitates, bi-monthly Medicaid Oversight and Operations inter-departmental Team. Also serves as the liaison with vendors and internal functional areas and assists in the coordination of the contract with Medicaid Division for the State and also represents BCBS at key State meetings. This position must ensure that operations run effectively and efficiently, while meeting all contract requirements and performance standards. Provides direction and training to staff. Adherence to compliance and audit requirements is essential. Serves as primary contact for external audits on Medicaid Business; directs the internal activities during such reviews and audits

* Bachelor Degree in Business with 6 years experience OR 10 years experience working in health insurance operations.
* 5 years management experience.
* Demonstrated experience in project management.
* Medicaid operational experience.
* Knowledge of contract and rate reimbursement provisions relating to hospital, home health agencies, nursing facilities, and other Medicaid providers.
* Demonstrated ability to work directly with corporate leadership.
* Leadership, organization, self-motivation and initiative skills.
* Demonstrated ability to manage multiple complex priorities.
* PC proficiency to include Word, Excel, and Lotus Notes.
* Analytical skills and presentation skills.
* Verbal and written communication skills.
* Presentation skills to speak to large audiences and meeting facilitation skills for external agency meetings.


* Experience with government contracts.
* Management experience in a health care or managed care environment
* Experience in the health care industry.

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