Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Director, Medicaid Initiatives

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Manager & Professional
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180001IM Requisition #
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Own the Medicaid Contract and ensures that operations conform to the contract through active partnership with Compliance, care management, tower leads and CTS. Oversee Medicaid communications. Oversee the implementation of new Medicaid initiatives and manages readiness reviews. Utilize knowledge and experience to promote business opportunities and working relationship with government agency; to keep abreast of changes in government program regulations; and to maintain compliance.

 

Responsibilities:

  • Develop expertise across the organization in the Medicaid/HARP/CHP programs and all of its programmatic requirements.

  • Maintain a working knowledge of relevant issues, laws and regulations affecting the organization and industry; serve as subject matter expert on requirements related to Medicaid/HARP/CHP products and operations.

  • Oversee operational processes to ensure compliance with DOH contracts.

  • Identify risks and opportunities; develop recommendations to improve processes in anticipation of, and in response to, changes in business/marketplace environment, regulations, etc.

  • Attend plan meetings with DOH and is the external face of the plan with regulatory agencies.

  • Run the monthly Medicaid Operating Committee, reports on policy changes, performance metrics, and external strategies in collaboration with other partners on the Medicaid team.

  • Communicate Medicaid/HARP/CHP policy across the organization.

  • Identify, hire, & train staff members, developing them into strong leaders and creating high-performing, self-directed teams. 

  • Develop succession plan to ensure talent pipeline.

Qualifications:

  • Bachelor’s degree

  • Master’s degree preferred

  • Exceptional ability to understand government regulations and apply that knowledge to large, complex operational processes

  • Excellent communication skills (verbal, written, presentation); and the ability to interface effectively with EmblemHealth Corporate senior management

  • Demonstrated interpersonal skills and ability to build strong working relationships with internal and external customers

  • Exceptional organizational skills with attention to detail and accuracy

  • Ability to work in a fast-paced and constantly changing environment while remaining positive & strategically focused; and to prioritize work against many competing priorities and client expectations

  • Proficient in Microsoft Suite of applications (Word, Excel, PowerPoint, Outlook)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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