PROGRAM DELIVERY LEAD

Accountabilities: • Lead the strategy, implementation, and ongoing operational execution of Medicaid revenue optimization and member activation programs. • Develop and execute multi-year program roadmaps aligned with organizational growth, financial, operational, and member engagement objectives. • Lead initiatives involving SSI eligibility identification and conversions, ESRD Medicare and non-dual-to-dual transitions, member activation, engagement programs, and condition-based solutions. • Identify opportunities to improve program performance, financial outcomes, member engagement, and overall member experience. • Monitor leading and lagging performance indicators and proactively address risks, barriers, and opportunities. • Oversee end-to-end program delivery, from strategic planning and implementation through ongoing operations and optimization. • Establish effective operational frameworks, governance structures, KPI reporting, and performance-management processes. • Remove barriers affecting outreach effectiveness, encounter acceptance, provider documentation, member engagement, and vendor execution. • Ensure programs can be effectively scaled across multiple Medicaid markets while accounting for market-specific requirements. • Build and maintain strong partnerships across Finance, Clinical and Care Management, Compliance, Procurement, Member and Provider Engagement, Encounters Operations, Medicaid Market Leadership, and Actuarial teams. • Facilitate executive-level discussions around performance, opportunities, risks, and mitigation strategies while driving accountability across stakeholders. • Lead strategic relationships with external vendors supporting member engagement and revenue optimization initiatives. • Establish vendor performance expectations, monitor contractual outcomes, and evaluate capacity, quality, operational efficiency, and financial value. • Partner with vendors to develop innovative approaches that improve member activation and program completion rates. • Quantify business opportunities and expected financial outcomes, developing business cases and ROI analyses for program enhancements and market expansion. • Monitor revenue realization, cost structures, forecasts, financial risks, and overall program economics. • Present performance results, recommendations, and strategic opportunities to senior and executive leadership. • Support the launch and expansion of programs into new Medicaid markets while navigating state-specific regulatory requirements and approval processes. • Evaluate emerging revenue optimization opportunities and member engagement strategies and drive continuous improvement and innovation. • Lead organizational change and adoption across complex, matrixed teams. Requirements: • Bachelor's degree required. • 5+ years of experience within Medicaid, Medicare, managed care, revenue optimization, risk adjustment, care management, health plan operations, or a closely related healthcare environment. • 5+ years of technical experience and at least 2 years of project leadership experience. • Demonstrated success leading enterprise-scale, cross-functional initiatives from strategy through implementation and operational execution. • Strong understanding of Medicaid financing, revenue optimization, business case development, forecasting, and ROI analysis. • Strong financial and analytical capabilities, with the ability to translate operational and financial data into actionable business insights. • Experience managing external vendors and establishing performance governance and accountability. • Strong knowledge of Microsoft Office applications, including Word, Excel, and Access. • Excellent written and verbal communication skills, with confidence engaging stakeholders at multiple organizational levels. • Strong relationship-building and influencing skills, including the ability to lead and influence without direct authority. • Demonstrated ability to navigate complex, matrixed organizations and build alignment across diverse stakeholder groups. • Strong program management skills and a proven ability to manage multiple priorities while maintaining operational rigor. • Passion for improving consumer and member experiences within a healthcare environment. • Strong change-management capabilities and the ability to drive adoption across teams. • Experience with healthcare or managed care environments is preferred. • A master's degree in business administration or a related field is a plus. • PMP or Six Sigma certification is advantageous. • Experience with Power BI, Databricks, SQL, or similar analytical and technical tools is preferred. • Strong data-driven decision-making skills and comfort working with operational and financial performance data. Benefits: • Annual salary: $115,200–$158,400, with individual compensation varying based on geographic location, skills, experience, education, certifications, and other job-related factors. • Eligibility for a bonus incentive plan based on organizational and/or individual performance. • Full-time schedule of 40 hours per week. • Fully remote position available nationwide within the United States. • Medical, dental, and vision benefits. • 401(k) retirement savings plan. • Paid time off, company holidays, and personal holidays. • Paid parental and caregiver leave. • Short-term and long-term disability coverage. • Life insurance. • Professional development and continued education opportunities. • Remote-work flexibility supported by established technology and home-office requirements. • Opportunity to lead high-impact Medicaid programs spanning revenue optimization, member activation, market expansion, and operational transformation. • Occasional travel to office locations may be required for training or meetings. • Home internet connection of at least 25 Mbps download and 10 Mbps upload is required, along with a dedicated workspace suitable for protecting confidential health information. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1