Assistant Director of Medicaid & Integrated Products

Overview

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.The Assistant Director of Medicaid and Integrated Products is primarily responsible for guiding the planning, execution, and administration of Medicaid Managed Care, as well as supporting the MLTC & Integrated Products lines of business. Core responsibilities include assisting in the direction of product ideation, development, implementation, and continuous improvement; competitive landscape analyses and market trend monitoring in New York and regional areas; supporting the identification & development of member growth & retention strategies; leading high-visibility, cross-functional product initiatives and regulatory implementations, and overseeing the development of regulatory Medicaid member materials. The successful candidate will also co-lead Federal and State policy and regulatory analysis impacting Medicaid products, and leverage analytics to support ongoing advocacy and/or product performance monitoring.

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

Product Strategy and Innovation

• Serves as Medicaid Product SME to internal operational, technical, regulatory, clinical, and other cross-functional teams to support the exploration, coordination, and implementation of new Medicaid products, service area changes, and/or benefit designs, DOH and/or CMS required regulations, and/or strategic improvement initiatives.
• Evaluates, develops, and builds new offerings within Medicaid and integrated benefits program including liaising with cross-functional stakeholders and government agencies on regulatory submissions, regulatory communications, readiness reviews, and overall product build & ongoing implementation. 
• Develops and leads systematic competitive intelligence monitoring and tracking such as benefit design and vendor utilization, product/plan offerings, membership and enrollment trends, service area modifications, mergers and acquisitions, and marketing and promotion efforts. 
• Conduct in-depth research on business and market trends, product analyses, and competitive intelligence to leadership teams for strategy development.

 

Federal and State Regulatory and Policy Analysis & Oversight  

• Monitor and track Federal and State policies & regulations that impact Medicaid and integrated benefit products across contractual obligations, eligibility, enrollment, marketing, benefits offering, utilization management, and other areas.
• Analyze and interpret CMS and State contractual requirements and updates across all products (e.g., model contracts, state Medicaid agency contract)
• Assess and evaluate Federal and State regulatory and policy impacts on products’ growth and operations, and summarize risks or opportunities with business stakeholders in plan-wide forums.
• Support internal leadership and external audiences (e.g., government agencies, association groups) in defining advocacy points, recommendations or suggestions in response to proposed regulations or policies, and coordinate responses to the State on behalf of the organization
• Lead and/or support Medicaid, Managed Long-Term Care, and Integrated Product regulatory reporting
• Reviews member communications and coordinate with internal teams to ensure regulatory compliance and implementation according to Medicaid managed care requirements.

 

Product Analytics and Optimization 

• Partner