Position Purpose: Lead the development, implementation, and ongoing optimization of Medicaid benefit programs and supporting vendor solutions throughout the product life cycle. Partner with regional Medicaid markets to translate member needs, regulatory requirements, and market priorities into differentiated benefits that improve member value, outcomes, and experience while supporting financial and growth objectives.
Drive vendor strategy, selection, contracting, implementation, governance, performance management, and consolidation; use utilization, spend, and outcome data to strengthen benefit performance and operational efficiency. Influence cross-functional partners—including Product, Regulatory Compliance, Finance, Analytics, Operations, and market leadership—to deliver a compliant, scalable, and competitive Medicaid benefit portfolio.
Key Details : Remote role within the continental United States. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Manage vendor contracting activities, including vendor selection support, contract and SLA development, negotiations, amendments, and renewals.
Lead vendor and benefit implementations, transitions, and de-implementations to ensure timely, effective execution. Oversee vendor relationships, governance, and performance review activities to strengthen accountability and service delivery. Develop vendor and benefit strategies that support market goals and departmental and corporate objectives. Drive vendor optimization and consolidation initiatives to reduce complexity, improve operational efficiency, and maximize financial performance.
Design, implement, and continuously improve benefit operations, processes, and workflow best practices. Analyze vendor utilization, spend, and financial performance to identify trends and recommend improvement opportunities. Partner with Analytics teams to develop reporting and tools that measure benefit utilization, effectiveness, and member outcomes. Identify opportunities to enhance existing products and services to improve clinical, financial, product appeal performance to better align with competitors.
Design, develop and manage new and existing products from initial conception through service delivery, including auditing of all assigned plan benefit package reviews. Monitor market trends to identify new product opportunities and enhancements to existing products. Review product performance and outcomes based on cost and benefit analyses and make recommendations for product improvements. Implement ongoing internal and external product trainings to improve product outcomes.
Effectively and proactively communicate details to market leaders and other partners. Support leadership and partnership with sales and market to drive optimized and competitive growth opportunities. Provide knowledge, mentorship and leadership to peers and team members to enhance overall team performance. Learn and utilize effectively the internal tools and sources of truth, HPMS PBP module, as well as CMS regulatory memos/releases.
Actively participates and engages in meetings. Attention to detail with superior work quality. Adherence to established project deadlines. Ability to effectively manage added workload during peak season. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's degree in related area or equivalent experience. Master's degree preferred.
5+ years of product and services development and management, including experience with assigned product(s). Previous experience as a lead in a functional area, managing cross functional teams on large scale projects, CMS experience and/or experience with annual Medicare Advantage bid process is preferred. Medicaid plans, vendor manag