Director of Medicaid
Oregon, Washington, Utah and Idaho (remote work available in these states)
Primary Job Purpose
The Director of Medicaid is the voice of Medicaid internally and externally reporting to the SVP, Government Programs. The Director of Medicaid is accountable for the Profit and Loss of the line of business. This leader is responsible for the strategy, business cases development and implementation of Medicaid in one or all of our four states. This includes overall performance of the market Medicaid line of business program, a focus on financial performance and membership growth. Oversees all aspects of market Medicaid programs, state contracting arrangements, product development, compliance with State and Federal Policies and requirements and partnerships with other divisions. Strategically builds, manages and sustains external business relationships, particularly with state and local regulators. Accountable for product development, administrative processes, interdepartmental communication and regulatory requirements. Develops an annual strategic plan and updates executive leadership on strategic issues/development, business performance and progress against objectives. Demonstrated passion and creativity in developing models of care serving low-income vulnerable populations.
General Functions And Outcomes
The position is responsible for the customer experience, achieving membership growth targets, overseeing & developing the Medicaid product portfolio and developing/executing market Medicaid strategy based on state and CMS requirements, national standards and alignment with overall national and market strategy. This position incorporates care delivery requirements into strategy and develops a strong partnership with the medical group and health plan delivery system.
Normally To Be Proficient In The Competencies Listed Above
Minimum 10 years of relevant experience in a Medicaid managed care organization. Minimum 7 years of management experience. Minimum 5 years in product line management to special populations. Bachelor’s degree or 4 years relevant experience.
The Director, Medicaid must have a strong background working with Medicaid and/or Special Populations and unique health care needs. Must be a decisive, results-oriented leader of people, be able to work in a highly matrixed environment and have strong collaborative skills. Additional competencies include:
- Understanding of state and federal Medicaid framework and regulatory requirements
- Excellent negotiation skills, verbal/written communication skills
- Strong analytical and strategic planning skills
- Excellent public presentation skills
- Strong persuasive and interpersonal skills
- Product and Program development skills
- Knowledgeable of Medicaid health care delivery systems
- Knowledgeable of current trends in care management and industry related to care delivery to Medicaid population
- Demonstrated ability to build effective partnerships and influence others who may have different perspectives
1-5 direct reports
Work is primarily performed remotely
Travel may be required, locally or out of state
May be required to work outside normal hours
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We’ve been here for members for 100 years. Regence is a nonprofithealth care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largesthealth insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you’re seeking a career focused on making the health care experience simpler, better, and more affordable for people and their families, consider joining our team at Cambia Health Solutions. Cambia is a total health solutions company that is deeply rooted in a 100-year legacy of transforming the industry and the way people experience health care. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future. Cambia is committed to delivering a seamless, personalized health care experience for the next 100 years.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.