Director, Medicaid Programs- JHP

About the role

The Director of Medicaid Programs is a senior leadership role responsible for driving the company’s regulatory, policy and growth strategy across a complex and rapidly evolving healthcare landscape. This position demands a deep and comprehensive understanding of federal and state regulatory frameworks governing the Medicaid program. The Director will lead the Medicaid policy strategy to ensure the company not only meets but anticipates regulatory requirements, leverages growth opportunities and competitive positioning, and minimizes risk while enabling strategic business growth and innovation. As a key member of the policy and regulatory affairs leadership team, the Director will influence policy interpretation, regulatory submissions, and cross-functional alignment. The Director will lead strategic development of Medicaid growth strategy and direction, driving new and innovative policy solutions that will advance growth in the Medicaid line of business. This role requires a visionary leader who can manage, mentor, and inspire a high-performing team of policy and regulatory professionals, fostering a culture of accountability, continuous learning, and proactive problem-solving. The Director will serve as the authoritative voice on Medicaid policy matters, cultivating strong relationships with regulators, industry stakeholders, and internal partners to navigate regulatory complexities effectively and strategically position the company in the marketplace. Primary Location Address: 1101 Market, Philadelphia, Pennsylvania, United States of America. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Responsibilities

• Develop and execute comprehensive policy and regulatory strategies to both ensure full compliance with Medicaid program requirements and advance long-term growth and sustainability goals for the Medicaid line of business.
• Identify opportunities for enrollment growth, improved quality performance, and integration with provider system initiatives.
• Use market intelligence and policy insights to anticipate changes in the Medicaid landscape and position the plan for long-term success.
• Implement strong project management and governance structure to drive forward cross-functional tactics that will position the Medicaid line of business for long-term success.
• Develop and maintain an actionable, measurable ongoing annual strategy for growth and retention of Medicaid members, working collaboratively to translate policy ideas into operational implementation.
• Conduct in-depth analysis of state and federal Medicaid policy trends, funding mechanisms, and program reforms.
• Advise executive leadership on strategic implications of regulatory developments, including potential impacts on rates, benefits, eligibility, and enrollment.
• Align Medicaid policy strategy, where appropriate, with the parent delivery system’s goals and value-based care initiatives.