VNS Health
Overview
Oversees the strategic planning and administration for VNS Health Mainstream Medicaid Plan along with launch of IB Dual Status, focusing on product growth and performance against defined goals and criteria. Collaborates with Health Plan leadership in the development of a business plan that is aligned with the strategic goals and objectives of the organization. Ensures compliance with all applicable contracts and government regulations. Leads the end-to-end development, implementation, and operational oversight of our Mainstream Medicaid product in New York State. Possesses a deep understanding of Medicaid regulations, experience with government-sponsored health programs, and the ability to manage complex, cross-functional initiatives. Translates state and federal policy into actionable business plans, ensures operational readiness, and drives alignment across clinical, operational, and compliance teams. Ensures successful product performance, regulatory adherence, and long-term growth in New York's Medicaid Managed Care market.
What We Provide
Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will do
Translates Medicaid and Medicare regulatory requirements into scalable operational processes.
Leads cross-functional steering committees to ensure enterprise-wide understanding and alignment with policy changes.
Drives continuous improvement initiatives that enhance member experience, compliance, and operational efficiency.
Directs Medicaid service-area expansion strategy, application development, and state submission processes.
Coordinates with internal departments (legal, provider network, finance) to ensure all expansion requirements are met.
Serves as point of contact with New York State Department of Health (DOH) regarding expansion approvals and follow-ups alongside Government Affairs.
Leads the development and launch of IB-Duals products, managing state applications, governance structures, and implementation timelines.
Oversees the build-out of member materials, ID card integration, portal experience, and state-specific reporting tools.
Ensures all requirements from both Medicare and Medicaid regulators are met across systems and operations.
Partners with Compliance to create a decentralized triage and accountability structure for Mainstream Medicaid regulatory issues.
Monitors regulatory updates and model contract changes, ensuring proactive operational response and documentation.
Supports internal audits, readiness assessments, and corrective action plans.
Supports and guides project managers and initiative owners across departments to deliver Medicaid-related initiatives on time and within scope.
Balances stakeholder needs, timelines, and compliance risks, while maintaining visibility to senior leadership.
Leads initiative tracking and reporting to ensure key milestones and metrics are achieved.
Owns preparation for DOH operational readiness reviews, including coordination of documentation, operational walkthroughs, and follow-up deliverables.
Identifies and resolves gaps in compliance or implementation prior to state evaluations.
Serves as primary liaison for state auditors during Medicaid audits and reviews.
Collaborates with Medical Management, Behavioral Health, and SDoH teams to align workflows with the model of care.
Ensures operational support for care management, member engagement, and clinical programs.
Participates in care model innovation, benefit design, and member experience improvement initiatives.
Collaborates with the Implementations team tasked with managing systems and data configurations related to eligibility, benefits, claims processing, and provider data accuracy.
Oversees submission of state-required reports, such as MMCOR, PND, and encounter data files.
Ensures integrity of provider directories, network reports, and regulatory submissions.
Qualifications Education:
Bachelor’s Degree in Business Administration, Healthcare Administration, Marketing or related field of study required. Master’s Degree in related field (MPH, MBA, MPA, or equivalent) preferred.
Work Experience:
Minimum 7 years of experience in a health insurance organization with a focus on one or more of the following product lines: Medicaid managed care, Managed Long Term Care, Commercial or Special Needs Plans and a minimum of one year of experience in product management required. Progressive experience in health care administration, planning and financial oversight required. Knowledge of Health Plan product assessment and development required. Project management and Medicaid managed care experience required. Ability to manage P&L for Medicare/Medicaid Plans required. Demonstrated ability to collaborate and interact cooperatively with all levels of management and their staff required. Experience with health plan operations, compliance, and audits required. Familiarity with Medicaid Managed Care Model Contract in NYS required. Proficiency in managing data/reporting requirements and system implementation required. In-depth knowledge of New York State Medicaid programs and policy, including Mainstream Medicaid, HARP, MLTC, and/or IB-Duals required. Experience working with regulatory bodies (e.g., NYS DOH, CMS) required. Experience working with benefit design, provider networks, medical management, marketing strategies and tactics, and claims required. Effective communication skills, both written and oral, and strong common PC software applications (i.e. Microsoft Office) skills required.
Pay Range USD $137,800.00 - USD $183,800.00 /Yr.
About Us VNS Health
is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
#J-18808-Ljbffr
What We Provide
Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will do
Translates Medicaid and Medicare regulatory requirements into scalable operational processes.
Leads cross-functional steering committees to ensure enterprise-wide understanding and alignment with policy changes.
Drives continuous improvement initiatives that enhance member experience, compliance, and operational efficiency.
Directs Medicaid service-area expansion strategy, application development, and state submission processes.
Coordinates with internal departments (legal, provider network, finance) to ensure all expansion requirements are met.
Serves as point of contact with New York State Department of Health (DOH) regarding expansion approvals and follow-ups alongside Government Affairs.
Leads the development and launch of IB-Duals products, managing state applications, governance structures, and implementation timelines.
Oversees the build-out of member materials, ID card integration, portal experience, and state-specific reporting tools.
Ensures all requirements from both Medicare and Medicaid regulators are met across systems and operations.
Partners with Compliance to create a decentralized triage and accountability structure for Mainstream Medicaid regulatory issues.
Monitors regulatory updates and model contract changes, ensuring proactive operational response and documentation.
Supports internal audits, readiness assessments, and corrective action plans.
Supports and guides project managers and initiative owners across departments to deliver Medicaid-related initiatives on time and within scope.
Balances stakeholder needs, timelines, and compliance risks, while maintaining visibility to senior leadership.
Leads initiative tracking and reporting to ensure key milestones and metrics are achieved.
Owns preparation for DOH operational readiness reviews, including coordination of documentation, operational walkthroughs, and follow-up deliverables.
Identifies and resolves gaps in compliance or implementation prior to state evaluations.
Serves as primary liaison for state auditors during Medicaid audits and reviews.
Collaborates with Medical Management, Behavioral Health, and SDoH teams to align workflows with the model of care.
Ensures operational support for care management, member engagement, and clinical programs.
Participates in care model innovation, benefit design, and member experience improvement initiatives.
Collaborates with the Implementations team tasked with managing systems and data configurations related to eligibility, benefits, claims processing, and provider data accuracy.
Oversees submission of state-required reports, such as MMCOR, PND, and encounter data files.
Ensures integrity of provider directories, network reports, and regulatory submissions.
Qualifications Education:
Bachelor’s Degree in Business Administration, Healthcare Administration, Marketing or related field of study required. Master’s Degree in related field (MPH, MBA, MPA, or equivalent) preferred.
Work Experience:
Minimum 7 years of experience in a health insurance organization with a focus on one or more of the following product lines: Medicaid managed care, Managed Long Term Care, Commercial or Special Needs Plans and a minimum of one year of experience in product management required. Progressive experience in health care administration, planning and financial oversight required. Knowledge of Health Plan product assessment and development required. Project management and Medicaid managed care experience required. Ability to manage P&L for Medicare/Medicaid Plans required. Demonstrated ability to collaborate and interact cooperatively with all levels of management and their staff required. Experience with health plan operations, compliance, and audits required. Familiarity with Medicaid Managed Care Model Contract in NYS required. Proficiency in managing data/reporting requirements and system implementation required. In-depth knowledge of New York State Medicaid programs and policy, including Mainstream Medicaid, HARP, MLTC, and/or IB-Duals required. Experience working with regulatory bodies (e.g., NYS DOH, CMS) required. Experience working with benefit design, provider networks, medical management, marketing strategies and tactics, and claims required. Effective communication skills, both written and oral, and strong common PC software applications (i.e. Microsoft Office) skills required.
Pay Range USD $137,800.00 - USD $183,800.00 /Yr.
About Us VNS Health
is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
#J-18808-Ljbffr