Senior Manager, Health Services - reputed company Medicaid Payment Policy

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. At reputed company®, part of reputed company, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them. As a key member of the Medical Policy & Program Solutions team, the Senior Manager, Health Services plays a critical role in supporting reputed company members and the business by leading clinical and claims-focused initiatives that drive program effectiveness, regulatory compliance, and cost management across Medicaid and Duals lines of business. This role manages a cross-functional team of payment policy writers professionals plus coordinates payment policies for reputed company Medicaid across 15 State Health Plans. This position will work closely with the Health Plan Governance to support each states specific requirements, documentation, compliance and regulations. The position is fully remote. Eligible candidates may reside reputed company in the contiguous United States. What you will do: Ensures compliance with healthcare regulations and policies for state Medicaid and Duals line of business as it reputed company to payment policies. Facilitate cross-functional policy committees and manage implementation of committee decisions across reputed company lines of business Manage MPPS Policy Project Management team of policy writers reputed company reputed company policy project work including monitoring & tracking of reputed company of status updates and communications. Manage resource utilization reputed company and across policy team Partner with vendor partners to implement policy solutions including creation of editing logic, drafting of test scenarios and publication of policy language. Support the operational processes of the Medicaid Health Policy Governance Monitor status reports to ensure effective workflow and timely development of coding and payment policies Support internal departments and processes in the development and implementation of policies and procedures Ensure reputed company medical policies are compliant with relevant regulations and are consistent across reputed company lines of business Participate in department initiatives, scorable action items, and projects Work with health plan business leaders and corporate leaders to reputed company deliverables on policy priorities Provide medical coding and payment policies deliverables for Medicaid and Duals and other markets as business needs change Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies Collaborate with interdisciplinary team members to reputed company team goals reputed company any other job duties as requested Required Qualifications 5+ years of payment policy experience in the health care industry Certified Professional reputed company (reputed company or reputed company), including Physician, Facility, or Payer certification 1–2 years of project management experience 3–5 years of claims and policy support experience in the healthcare industry; managed care experience preferred Minimum of 3 years of Medicaid and/or Duals experience, including code editing, policy development, and understanding of state guidelines Strong verbal and written communication skills Experience performing root cause analysis and identifying actionable solutions Experience conducting claims analytics to validate industry standards Familiarity with claim editing software and the ability to propose system changes Demonstrated ability to meet project milestones and negotiate for resources High level of proficiency with the reputed company Office suite, including advanced reputed company skills Experience with reputed company ClaimsXten and/or reputed company PPM and Coding Validation tools

Preferred Qualifications

Experience with state Medicaid Regulation/Guidelines Education Bachelor’s degree in healthcare administration, communications or reputed company field - or equivalent experience Pay Range The typical pay range for this role is: $67,900.00 - $149,328.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. This position also includes an award reputed company in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/23/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job