Patient Benefits Manager (Medicaid Experience Required)

About POD Health

At POD Health, we improve patient outcomes by combining technology with personalized, accessible care. Our integrated clinical and support services help patients manage their health while addressing barriers that may affect their ability to receive and maintain appropriate care.

As POD Health continues to expand, our Social Services Coordination (SSC) team plays an increasingly important role in helping patients navigate healthcare benefits, government programs, community resources, and other services that support their health and well-being.

Position Summary

POD Health is seeking an experienced Manager of Patient Benefits to lead and develop our growing Social Services Coordination team.

This individual will serve as a subject matter expert in Medicaid eligibility, patient benefits, government assistance programs, and community resource navigation. The Manager will provide hands‑on guidance and training to the SSC team, assist with complex patient cases, develop standardized workflows, and ensure patients are connected with appropriate resources in a timely and compliant manner.

The ideal candidate has significant experience with Medicaid applications, renewals, recertifications, spend‑down cases, pooled income trusts, case corrections, code removals, eligibility issues, and other complex Medicaid matters that may otherwise require outside Medicaid consulting support.

Beyond New York expertise, this individual will help POD Health build its patient resource infrastructure as the organization expands into additional states, including Florida and Colorado — researching state‑specific Medicaid programs, benefits, community resources, and referral organizations, and translating those findings into practical workflows for the team.

This is a leadership and subject matter expert position for someone who can not only manage a team, but teach that team to handle increasingly complex patient needs independently.

Key Responsibilities

Team Leadership & Development

• Lead, supervise, coach, and develop the Social Services Coordination team
• Serve as the team's primary subject matter expert for complex Medicaid, benefits, and social‑service cases
• Provide structured training, case reviews, mentorship, and ongoing education
• Develop training materials, reference guides, standard operating procedures, and escalation pathways
• Review difficult or unusual cases with staff and provide clear recommendations for next steps
• Support performance management while maintaining a collaborative, educational, patient‑centered team environment
• Identify knowledge gaps and create targeted training to improve team capabilities

Medicaid & Benefits Expertise

Provide advanced support for Medicaid‑related matters, including:

• Applications and enrollment
• Renewals and recertifications
• Eligibility verification
• Spend‑down and excess‑income cases
• Pooled income trust coordination
• Case corrections
• Code removals and restriction issues
• Coverage reinstatement
• Coverage gaps and eligibility discrepancies
• Changes in income, assets, household composition, or residency
• Medicaid managed care issues
• Long‑term care and home‑care Medicaid pathways
• Coordination with Medicaid agencies, managed care organizations, and other governmental entities

Review complex cases that would traditionally require referral to an outside Medicaid consultant, and determine when external legal or specialized assistance remains necessary.

Patient Benefits & Resource Navigation

Oversee and support the team's work connecting patients with services such as:

• Home care and long‑term care resources
• Medicaid and other insurance programs
• SNAP and food assistance programs
• Transportation assistance
• Housing and utility resources
• Durable medical equipment and related benefits
• Personal emergency response and safety resources
• Adult day and community‑based programs
• Financial assistance programs
• Government benefits
• Community and nonprofit organizations
• Other health‑related social needs identified by patients or the clinical team

Maintain and continuously improve an organized resource library for the SSC team.

Multi‑State Program Development

• Research Medicaid programs, government benefits, community organizations, and patient assistance resources in states where POD Health operates
• Develop state‑specific resource directories and workflows for New York, Florida, and Colorado
• Identify differences in eligibility requirements, application processes, available benefits, and referral pathways between states
• Establish relationships with governmental agencies, community organizations, managed care plans, and other resource partners
• Train SSC staff on state‑specific programs and escalation procedures
• Support leadership with operational planning as POD Health expands into additional markets

Case Oversight & Quality Assurance

• Review complex, delayed, or escalated patient cases
• Conduct regular audits of case documentation, follow‑up activity, outcomes, and timeliness
• Ensure each case has a clearly documented status, next action, responsible party, and follow‑up plan
• Identify recurring barriers and develop operational solutions to prevent delays
• Monitor unresolved cases and assist staff with escalation when necessary
• Ensure appropriate documentation and confidentiality standards are maintained

Workflow & Program Development

• Evaluate existing SSC workflows and identify opportunities for improvement
• Develop standardized processes for common patient benefit and social‑service needs
• Establish clear criteria for when cases should remain with an SSC, be escalated to management, or be referred to an outside specialist
• Partner with leadership to reduce dependence on outside Medicaid consultants by building internal expertise
• Develop tools, templates, checklists, and standardized documentation practices
• Help define meaningful productivity, quality, and patient‑outcome metrics for the department

Interdepartmental Collaboration

• Partner with clinical, care management, operations, billing, compliance, and leadership teams to address patient barriers to care
• Serve as a resource to staff when Medicaid or benefit issues affect a patient's ability to receive services
• Communicate significant policy or program changes to leadership and affected departments
• Participate in cross‑functional initiatives aimed at improving patient access and continuity of care

Regulatory & Program Knowledge

• Maintain current knowledge of Medicaid regulations, eligibility requirements, government benefit programs, and relevant state and federal changes
• Translate regulatory and program changes into practical guidance for frontline staff
• Ensure departmental processes remain consistent with applicable requirements and organizational policies

Qualifications

Required

• 5-7 years of direct experience with Medicaid eligibility, government benefits, social services, healthcare navigation, or a closely related field
• 2-3 years of supervisory, management, training, or senior‑level case oversight experience
• Strong working knowledge of New York Medicaid eligibility and enrollment processes
• Demonstrated experience handling complex Medicaid cases, including applications, recertifications, spend‑down, pooled income trusts, eligibility corrections, code removals, reinstatements, and coverage issues
• Experience working with Medicaid eligibility systems and government benefit portals
• Strong understanding of healthcare and community resources available to older adults, individuals with chronic conditions, individuals with disabilities, and underserved populations
• Demonstrated ability to research unfamiliar programs and develop clear operational guidance for others
• Strong training and staff‑development skills
• Ability to explain complex Medicaid and benefit requirements clearly to employees, patients, and families
• Strong organizational, documentation, problem‑solving, and case‑management skills
• Ability to independently manage complex cases while developing the capabilities of a growing team

Preferred

• Experience in healthcare, managed care, home care, social services, Medicaid consulting, community‑based organizations, or government benefits
• Experience supporting patients across multiple states
• Familiarity with long‑term care Medicaid and home and community‑based service (HCBS) programs
• Experience developing SOPs, training programs, resource guides, and quality assurance processes
• Experience working directly with government agencies, managed care organizations, Medicaid offices, or benefits advocacy organizations
• Bachelor's or master's degree in social work, healthcare administration, public administration, human services, or a related field — may be substituted with significant relevant professional experience

Benefits

• Health, dental, and vision insurance
• 401(k) with company match
• PTO and paid holidays
• Professional development opportunities
• Mission‑driven work in an innovative healthcare space

Ideal Candidate

The ideal candidate is an experienced Medicaid and patient‑benefits professional who enjoys teaching others and solving complex cases. They should be comfortable stepping into a growing department, evaluating current processes, developing staff expertise, building resources for new markets, and serving as the team's trusted resource when a patient situation becomes difficult or unfamiliar.

Success in this role will be measured not only by individual case resolution, but by how effectively the Manager strengthens the knowledge, independence, consistency, and overall capabilities of the SSC team.