Note: The job is a remote job and is open to candidates in USA. Groups Recover Together is seeking an Associate Director/Director of Medicaid Entitlement & Coverage Strategy to lead their strategic response to federal Medicaid changes. This role involves becoming a Medicaid Qualified Entity across operating states, implementing documentation protocols, and training staff to support eligible members through the Medicaid enrollment process.
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
- 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
Skills
- Bachelor's degree required in social work, public health, public policy, health administration, or a related field
- Minimum of 8-10 years of experience in healthcare administration, entitlement services, social work, or a related field
- 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
- Master's degree preferred
- Experience working in or with a SUD treatment organization preferred
Benefits
- Fully Remote work (Not available to residents of: AK, AR, CA, HI, ID, MD, NE, SD, UT, WY).
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