Associate Director/Director, Medicaid Entitlement & Coverage Strategy

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for an Associate Director/Director, Medicaid Entitlement & Coverage Strategy based in the United States. This is a mission-critical leadership role focused on shaping and executing a multi-state Medicaid entitlement and coverage strategy in a rapidly evolving regulatory environment. You will be responsible for building and operationalizing systems that protect and expand Medicaid access for eligible members, while ensuring compliance with state and federal requirements. The role sits at the intersection of healthcare policy, operations, and technology, requiring both strategic vision and hands‑on execution. You will lead initiatives spanning Medicaid Qualified Entity (QE) enrollment, medical frailty documentation, and SSI/SSDI support programs, while driving measurable improvements in coverage retention and member outcomes. Acting as a key cross‑functional connector, you will collaborate with government affairs, clinical, product, and operations teams to translate complex policy changes into scalable workflows. This is a high‑impact role for a leader who thrives in dynamic, regulated environments and is motivated by improving access to care at scale. Accountabilities Drive the application and implementation process for Medicaid Qualified Entity (QE) status across eligible operating states, including coordination with legal teams and state Medicaid agencies. Oversee the rollout of SOAR training programs to equip staff in supporting SSI/SSDI applications and improving member access to federal disability benefits. Design and implement standardized medical frailty documentation protocols integrated into intake and annual review workflows. Build and maintain systems that identify members at risk of Medicaid loss, track eligibility milestones, and support redetermination and exemption processes. Partner with Government Affairs to monitor, interpret, and operationalize federal and state Medicaid policy changes across all operating regions. Collaborate with Product and Operations teams to design internal tracking systems for Medicaid eligibility, coverage gaps, and SSDI/SSI qualification pathways. Develop training programs in partnership with Learning & Development to ensure staff proficiency in Medicaid entitlement processes and related documentation requirements. Establish a comprehensive evaluation framework to measure coverage retention, enrollment outcomes, compliance rates, and program effectiveness, delivering regular leadership reporting. Support external engagement with state Medicaid agencies and other stakeholders on enrollment, redetermination, and coverage protection initiatives. Contribute to additional initiatives such as ACA Navigator certification deployment in non‑expansion states and other evolving program needs. Requirements 8–10+ years of experience in healthcare administration, public health, social services, Medicaid programs, or related entitlement‑focused roles. Strong expertise in Medicaid policy, including eligibility rules, redetermination processes, expansion vs. non‑expansion frameworks, and ACA‑related coverage structures. Experience working directly with state agencies, Medicaid programs, managed care organizations, or government stakeholders. Knowledge of SSI/SSDI eligibility and application processes, with the ability to support disability benefit navigation strategies. Familiarity with substance use disorder (SUD/OUD) treatment systems and Medicaid‑funded care pathways is a strong plus. Proven ability to manage complex, multi‑state initiatives with multiple stakeholders and competing deadlines. Strong analytical, organizational, and project management skills with experience using tracking systems and workflow tools. Excellent written and verbal communication skills, with the ability to translate complex policy into operational guidance. Ability to work independently, build programs from the ground up, and operate effectively in a remote, fast‑paced environment. Cross‑functional collaboration experience across clinical, operational, product, and government affairs teams. Bachelor’s degree required (public health, social work, public policy, health administration, or related field); Master’s degree preferred. Must meet background screening requirements and maintain eligibility for applicable state and program compliance standards. Reliable remote work setup with adequate internet connectivity required. Benefits Competitive salary range depending on level ($72,000 – $130,000 USD) Fully remote work model (with state eligibility restrictions) Comprehensive health, dental, and vision insurance coverage Paid time off and standard holiday benefits Opportunity to work on high‑impact Medicaid policy and access‑to‑care initiatives Professional development in healthcare policy, government programs, and entitlement systems Cross‑functional exposure across clinical, product, operations, and government affairs teams Potential supervisory and leadership growth responsibilities as the program expands Mission‑driven environment focused on improving healthcare access and coverage retention. #J-18808-Ljbffr Jobgether