Manager - Medicaid Solutions

What are important things that YOU need to know about this role?

• Experience Required: This is a true Medicaid leadership role. Medicaid must be the core of your experience
  • Deep, hands on Medicaid experience where Medicaid was your primary focus
  • Background in Medicaid operations, program management, or product management
  • Experience developing and executing member engagement and outreach initiatives, especially for underserved or marginalized Medicaid populations
  • Proven ability to lead and grow teams, including outreach or field based staff
  • Comfortable working in a growth environment, with teams and initiatives expected to scale quickly
• Work Location:
  • This is a full remote role
  • Moderate travel (20-25%) to Medicaid markets to work directly with clients and outreach teams

What will YOU be doing for us? The Manager, Medicaid Solutions is responsible for developing and executing cost-effective Medicaid programs to enhance Member engagement, quality, and care coordination. The Manager, Medicaid Solutions drives programs to improve dental service utilization through member engagement and utilization. The Manager, Medicaid Solutions works in conjunction with SKYGEN's clients to ensure the programs are aligned with the clients' objectives and goals. Key measures of success include HEDIS, ADA/DQA and other utilization metrics/measures, member engagement, initiative cost and ROI. The Manager, Medicaid Solutions develops and manages relationships with clients and other third parties to identify new program opportunities and ensure coordinated dissemination of information.

What will YOU be working on every day?

• Assist in developing and implementing Medicaid Solutions initiatives to improve access, quality, and efficiency of care
• Assist in building and maintaining strong relationships with Medicaid Clients, state/federal partners and other stakeholders that impact Medicaid programs
• Act as SME on SKYGEN Medicaid Solution products including Conditional Benefits, Provider Select Suite and others
• Recommend enhancements to Medicaid Solution products to improve functionality and better meet Client needs
• Assist in developing and implementing care coordination strategies, including case management and utilization management
• Develop and execute engagement strategies unique to targeted Member populations, based on eligibility coverage groups, health conditions, prior utilization, Client flagging or other unique attributes to encourage utilization of program benefits and services.
• Assist in developing proposal strategies for Medicaid contracts, including understanding RFP requirements and proposing solutions that align with SKYGEN's capabilities
• Collaborate with internal departments to ensure proposals are comprehensive, competitive and align with Client needs
• Understand Client needs and transition into actionable strategies
• Stay informed on the latest developments in Medicaid policy and program changes, determine operational impacts and adjust accordingly
• Assist in gathering, analyzing and compiling data related to Medicaid programs and initiatives
• Maintain an intimate understanding of Member populations and their unique needs.
• Supervise the efforts of Member outreach staff
• Assist Member outreach representatives and coordinator in creating events, managing budget for events and marketing those events.
• Oversee the development of reporting specific to each Medicaid Solution initiative to monitor performance and identify areas of improvement opportunity
• Resolve complex requests or escalated issues pertaining to Medicaid Solutions initiatives
• Foster an environment of continuous improvement through process and systematic enhancements to drive change
• Hire, develop, and motivate staff. Initiate and communicate a variety of personnel actions including employment, terminations, performance reviews, salary reviews, disciplinary actions, and development plans. Provide regular and behaviorally specific feedback to increase performance levels.
• Provide regular updates and presentations to leadership
• Act as SME in Client audits that review or examine Medicaid Solutions
• Track progress of ongoing projects

What qualifications do YOU need to have to be GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates
  • Bachelor's degree in Business or related field
• Required Level of Experience
  • 5-7 years of experience in a health/dental insurance or health/dental care setting
  • 5-7 years of experience in a management/leadership capacity
• Required Knowledge, Skills, and Abilities
  • Strong understanding of Medicaid Programs and regulations
  • Experience in leading cross-functional teams, managing projects and building relationships
  • Strong presentation skills
  • Ability to design communications and/or trainings to inform large groups of individuals effectively
  • Ability to identify trends within data
  • Ability to successfully analyze large amounts of data and provide succinct synopsis
  • Ability to develop larger long tern strategies with associated goals for improvement
  • Ability to develop strong relationships with others
  • Ability to organize work appropriately to meet deadlines.
  • Demonstrated use of Microsoft Office products (Word, Excel, and PowerPoint).

What qualifications do YOU need to have to be a GREAT candidate?

Preferred Qualifications

• Preferred Level of Education, License, and/or Certificates
  • Master's degree in Business or similar field
• Preferred Level of Experience
  • Experience with dental, medical and/or physical therapy administration
• Preferred Knowledge, Skills, and Abilities
  • Knowledge of Enterprise System

The salary range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Compensation Range: $86,594-$129,892

Compensation Midpoint: $108,243