Director of Medicaid – New York – NYC Health + Hospitals



About NYC Health + Hospitals

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Reporting to the Head of Product, the Director of Medicaid ensures operational excellence and regulatory compliance of all Medicaid products, owning the full spectrum of product strategy and operations. The Director will support key analytical activities to support the Plan’s strategic position, and will be proactive in identifying opportunities for performance improvement.

Job Description

• Provide oversight of Plan and vendor operations as they relate to the Medicaid line of business aligning outcomes to strategic goals & regulatory requirements.

• Develop & manage operational reports to track operational effectiveness.

• Partner with operational departments including Claims, Customer Service, Finance, Enrollment, Vendor Management, & Medical Management to design processes ensuring effective & efficient operations.

• Support key stakeholders in driving initiatives to meet quality & customer satisfaction goals.

• Maintain customer focus throughout Plan operations to ensure a seamless & excellent customer experience.

• Provide deep knowledge of & insight into the regulatory & market environment of Medicaid in New York to support the development of product strategy.

• Identify & integrate operational best practices, partnering with key departments to optimize processes across the organization such as benefits administration, risk adjustment, marketing & communications, customer experience.

• Monitor & analyze regulatory activity ensuring compliant operations & implementation.

• Perform competitive & market analysis.

• Partner with internal & external stakeholders on key strategic, regulatory, & operational projects.

Minimum Qualifications

• Bachelor’s degree from an accredited college or university in an appropriate discipline required.

• Master’s degree in business, healthcare or public administration strongly preferred.

• Minimum 5 years experience at a Health Plan with Medicaid Managed Care in a product management or compliance role.

• Thorough knowledge of Medicaid regulatory environment in NYS.

• Experience working with NYS enrollment transactions & encounter data submissions.

• Thorough understanding of interconnected managed care operations

• Demonstrated ability to develop workflows, policies, procedures.

• Demonstrated ability to identify opportunities for improvement & implement solutions.

• Excellent written & verbal communication skills.

• Excellent analytical skills demonstrated by an ability to use actionable data to support decisionmaking, and to proactively identify opportunities.

• Highly collaborative, and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making.

• Ability to take initiative & think independently

• Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values

Professional Competencies

• Leadership

• Results-driven

• Business acumen

• Systems orientation

• Process improvement

• Data-driven decision-making

• Customer focus

• Written/oral communication

• Resourcefulness

• Ability to work effectively in a fast-paced & constantly evolving environment

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