Associate Director, Healthcare Finance – Medicaid Strategy, Managed Care, Policy, Reimbursement

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $127.6k - $170k / year

⏰ Full Time

🟠 Senior

👨‍⚕️ Medical Director

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Sellers Dorsey

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

💼 Consulting

☁️ SaaS

Healthcare • Consulting • SaaS

Sellers Dorsey is a healthcare-focused strategy and impact firm that partners with health system leaders, payers, government agencies, and community organizations to design, fund, implement, and optimize programs for underserved populations. They provide consulting services including Medicaid optimization, policy research and interpretation, value-based care design, managed care contracting and strategy, operational performance and compliance, and custom data analytics and visualization. The firm also offers tech-enabled solutions (branded Constyn) for clinical workflows, care coordination, and payer data automation, and emphasizes program management, quality improvement, and stakeholder engagement to improve access, quality, and outcomes in safety-net and vulnerable communities.

📋 Description

• Manage Sellers Dorsey client engagements focused on Medicaid strategy and financing, managed care, and provider policy and reimbursement • Provide direct client consulting and leadership services in healthcare policy, strategy, and management • Support Directors and Senior Strategic Advisors in delivering healthcare consulting services • Manage senior-level client relationships and/or all policy and technical aspects of projects • Deliver strategic advice and counsel to business partners, states, private companies, associations, and unions • Provide policy guidance, project management, client deliverables, and client satisfaction • Identify new and expanded business activities • Interact with client financial leadership, including CFOs and Reimbursement Directors • Identify reimbursement methodologies and interpret financial records • Identify alternative Medicaid financing approaches and develop recommendations based on regulatory changes • Develop interactive financial models based on financing structures and state or federal laws • Maintain supporting data and ensure model accuracy through robust quality assurance processes • Safely manage and transfer client data and adhere to HIPAA • Travel to clients as required • Develop technical skills of direct reports • Perform project tasks and produce client-ready deliverables with minimal supervision • Deliver subject matter expertise and strategic services across multiple projects and engagements • Conduct primary research and solution development • Assist with proposals, project plans, data analysis, presentations, and client presentations • Serve as key client contact and primary contact for technical and financial project aspects • Interface with external client leaders, state government officials, CMS officials, state actuaries, consultants, trade associations, and other stakeholders • Leverage policy and healthcare solution expertise to develop and communicate solutions • Participate in brainstorming and conceptualization sessions • Collaborate with legal, regulatory, and compliance teams • Identify leads and opportunities for profitable revenue growth • Stay current on healthcare policies, regulations, and industry trends • Assist with proposal drafting, editing, scope development, budgeting, and cost estimation • Translate technical information for non-technical stakeholders • Seek new business opportunities and expand solutions for existing clients • Oversee direct reports, provide professional development, manage utilization, optimize resource allocation, and provide feedback • Engage clients to understand challenges and provide Medicaid business solutions and advice • Evaluate and refine solutions as Medicaid and healthcare conditions evolve • Perform ad hoc analyses regarding business investments and reimbursement methodologies

🎯 Requirements

• Bachelor's degree and 10 or more combined years in a public healthcare policy management role and/or in the healthcare consulting industry • 10 or more years of progressively responsible work experience in health or human services policy or finance, consulting and/or in a healthcare service delivery environment and/or with a Medicaid managed care organization, or 5+ years of post-graduate, progressively responsible work experience in consulting or operational experience in health care and/or health policy research/analysis • Ability to develop and clearly present complex data models to internal and external audiences • Ability to interpret and communicate new and existing federal guidance • Leadership and/or people management skills • Understanding of Medicaid financing and payments • Ability to develop and design Medicaid payment programs • Ability to assess Medicaid payment program limitations, including DSH payments and Fee for Service UPL • General knowledge of value-based and quality considerations • Ability to develop and design state-wide or local provider assessment programs • Knowledge of CMS submission processes for healthcare taxes and payments • Familiarity with State Plan Amendments and Pre-Prints, submission timelines, and data requirements • Understanding of existing CMS rulings and guidelines and ability to interpret new CMS rulings and guidelines • Understanding of allowable sources of non-federal share, including inter-governmental transfers, provider assessments, and certified public expenditures • General knowledge of Medicaid Waivers • Understanding of commercial reimbursement principles • Experience working with healthcare data such as claims sets and cost reports • Experience developing dynamic models using large datasets • Understanding of medical billing terminology and best practices • Familiarity with Medicare Hospital Cost Reports • Familiarity with publicly available CMS data and other healthcare datasets • Familiarity with data security and storage principles • Ability to provide mentorship and guidance to team members • Experience with state Medicaid agencies, CMS, or healthcare providers preferred • Demonstrated success in leading teams and managing complex projects • High proficiency in Microsoft Word and Excel required • Experience with querying languages such as SQL preferred • Familiarity with approved AI-enabled tools for Medicaid finance research, data analysis, financial modeling, proposal development, and quality review preferred • Validation of AI-assisted outputs for accuracy, regulatory relevance, and client confidentiality • Excellent oral and written communication skills • Ability to analyze and interpret federal and state policies and regulations • Ability to interact professionally with clients and outside audiences • Strong analytical and problem-solving skills • Experience in quantitative program evaluation highly desirable • Ability to work effectively independently and in teams • Experience delivering services on several projects simultaneously • Time management skills • Ability to develop and implement strategies integrating data analytics and insights into healthcare policy and management decisions

🏖️ Benefits

• Annual Corporate Incentive Plan (CIP) that can range to up to 15% of annual salary • Group healthcare plans offering medical, dental, and vision • Short-term disability, long-term disability, and basic life insurance plans • 401(k) plan • Flexible Time Off • 16 paid holidays throughout the calendar year • Paid time off for qualifying medical leave • Up to 12 weeks of combined paid parental and bonding leave