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Associate Director/Director, Medicaid Entitlement & Coverage Strategy

Groups Recover Together, Inc. -
Remote

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Job Details

Full-time
$72,000 - $130,000 a year
11 days ago

Qualifications

Affordable Care Act (ACA)
Collaborating with government agencies
Medicaid health insurance
Bachelor's degree
Government healthcare agency experience

Full Job Description

Overview:

The Associate Director/Director of Medicaid Entitlement & Coverage Strategy leads the organization's strategic response to federal Medicaid changes. This role will be responsible for positioning GRT to become a Medicaid Qualified Entity (QE) in all of its operating states where eligible, implementing a medical frailty documentation protocol, deploying SOAR (SSI/SSDI Outreach, Access, and Recovery) training across the organization, building internal infrastructure to directly enroll eligible members in Medicaid and support them through redetermination, and evaluating and reporting program outcomes to leadership.

This is a cross-functional role that requires exceptional organizational and communication skills, experience navigating state government systems, and the ability to drive complex multi-state initiatives independently and with urgency. While the initial focus of this role is standing up GRT's Medicaid entitlement and coverage strategy and infrastructure across all operating states, the ongoing scope and responsibilities of this position will evolve based on program needs, organizational growth, and the shifting federal and state Medicaid landscape.

Salary Range for Associate Director level: $72k-$118k. Salary Range for Director level: $95k-$130k

Fully Remote work (Not available to residents of: AK, AR, CA, HI, ID, MD, NE, SD, UT, WY).

Responsibilities:

Lead GRT's application process to become a Medicaid QE in all operating states where eligible, including working with GRT's legal counsel to submit Memoranda of Understanding (MOUs) to each state Medicaid agency, coordinating staff training, and ensuring ongoing compliance with state QE requirements
Oversee the implementation of SOAR training for designated staff across all operating states, ensuring trained staff are registered and equipped to assist members with SSDI and SSI applications; establish pre-release SSDI/SSI application pipelines through GRT's corrections partnerships where applicable
In partnership with GRT's medical and product leadership, develop, implement, and maintain a standardized medical frailty documentation protocol, ensuring the protocol is embedded into intake and annual review workflows across all Medicaid expansion states
Lead the development and implementation of systems, workflows, and member support strategies designed to help eligible members meet state Medicaid requirements. This includes identifying at-risk members, tracking compliance milestones, facilitating documentation of qualifying activities and exemptions, working with field teams to coordinate referrals to community resources, and working with operational teams to reduce avoidable coverage losses.
Support GRT's Government Affairs team by assisting with tracking federal and state legislation, regulations, and guidance related to Medicaid work requirements, presumptive eligibility, and One Big Beautiful Bill Act implementation across all operating states.
Collaborate with the Government Affairs Team in translating policy developments into actionable operational updates for GRT's teams in a timely manner
Support GRT's Government Affairs team in interacting with state Medicaid agencies and other stakeholders on matters related to QE enrollment, redetermination processes, and member coverage protection strategies
In partnership with the Product Team, design and maintain an internal tracking system to identify members at risk of losing Medicaid coverage due to redetermination,work requirements, documentation barriers or other eligibility challenges; members presenting without Medicaid coverage, and members who may qualify for SSDI/SSI
In partnership with the Learning and Development Team, develop and deliver training and educational resources for entitlement staff, counselors, and clinical providers on QE processes, medical frailty documentation, and SSDI/SSI application assistance
Develop and maintain a comprehensive evaluation framework that measures coverage retention, redetermination outcomes, work requirement compliance and exemption utilization, SSDI/SSI enrollment outcomes, and reasons for Medicaid disenrollment. Prepare regular progress reports and presentations for GRT leadership at defined milestones (90 days, 6 months, and 12 months)
Supervisory responsibilities to be determined based on organizational need and program growth.
This position may require occasional travel to GRT operating states for state agency meetings, staff training, or site visits.

Other Duties and Responsibilities:

Pursue ACA Marketplace Navigator certification for designated staff in GRT's non-expansion states to support members who are not eligible for Medicaid
Other duties as assigned

Qualifications:

Knowledge, Skills and Abilities:

Demonstrated knowledge of Medicaid policy, eligibility criteria, presumptive eligibility, redeterminations, the Affordable Care Act, including the differences between expansion and non-expansion states
Knowledge of SSDI and SSI eligibility criteria and application processes
Understanding of the opioid use disorder (OUD) treatment landscape and the potential role of Medicaid in funding Substance Use Disorder (SUD)/OUD treatment services
Demonstrated ability to manage complex, multi-state initiatives with competing deadlines and multiple stakeholders
Experience working directly with state government officials and Medicaid agencies
Excellent written and verbal communication skills, including the ability to present complex information clearly to diverse audiences
Proficiency in project management tools, tracking systems, and electronic health record platforms
Ability to work cross-functionally across clinical, medical, operational, and administrative teams in a fast-paced, remote organization
Self-starter with the ability to build and lead a program from the ground up with limited direction
Ability to use discretion and work independently
Ability to understand and adhere to the Code of Conduct

Qualifications & Requirements:

Bachelor's degree required in social work, public health, public policy, health administration, or a related field. Master's degree preferred
Minimum of 8-10 years of experience in healthcare administration, entitlement services, social work, or a related field. Experience working in or with a SUD treatment organization preferred
Demonstrated experience working with state agencies, government offices, or managed care organizations required
Access to reliable internet and telephone services, specifically 50M download and 10M upload package or higher as well as a strong WiFi signal from your remote work location
Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. Depending on state-specific requirements, this may include fingerprinting, drug testing,

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