Director of Medicaid

Position Purpose

The Director, Medicaid Strategy and Operations is a leadership role responsible for the strategic, financial, and operational performance of Renown Health’s Medicaid portfolio. This position provides enterprise-wide leadership to ensure Medicaid programs are financially sustainable, operationally effective, and aligned with value-based, population-focused care models.

Working closely with clinical, financial, operational, and external partners, the Director leads the development and execution of Medicaid strategies that improve quality outcomes, affordability, access, and member experience. The role serves as a key liaison with state agencies, Medicaid managed care organizations, and community partners, ensuring regulatory compliance, strong payer performance, and readiness for evolving policy and market dynamics.

This leader drives cross-functional alignment, performance management, and continuous improvement across Medicaid initiatives, while advancing innovation, health equity, and growth opportunities. The position plays a critical role in supporting Renown’s mission to improve the health and well-being of the communities it serves.

Nature and Scope

Operational and Financial Leadership:

• Provides enterprise-wide leadership for the strategic, financial, and operational performance of Renown’s Medicaid portfolio.
• Accountable for day-to-day oversight, optimization, and sustainability of Medicaid lines of business across the care continuum, including performance against financial, quality, access, and member experience goals.
• Leads and influences cross-functional teams to achieve strong operating results while advancing value-based, population-focused care models.
• Develops and oversees Medicaid financial strategies, including monthly revenue performance, annual earnings, shared savings arrangements, quality incentive programs, and long-term margin sustainability.

Compliance & Regulatory Readiness:

• Ensures ongoing compliance with CMS and Nevada Medicaid regulations, maintaining continuous audit readiness and operational preparedness for state and federal reviews. Interprets and operationalizes evolving regulatory requirements and translates them into effective, compliant workflows across clinical, financial, and operational teams.
• Reviews, monitors, and provides strategic input into Medicaid managed care contracts, ensuring contractual obligations are met, performance is optimized, and Renown is appropriately reimbursed.

Strategic Planning and Performance Management:

• Leads the development and execution of Medicaid strategies that improve quality, outcomes, affordability, and member experience.
• Uses data-driven insights, performance dashboards, and benchmarks to identify opportunities, mitigate risks, and drive continuous improvement.
• Partners closely with Finance, IT, Quality, Revenue Cycle, Population Health, and Clinical Operations to align Medicaid strategy with organizational priorities and system-wide initiatives.

Partnership and External Engagement:

• Serves as a primary operational and strategic liaison with state agencies, Medicaid managed care organizations (MCOs), providers, and community-based organizations. Builds and sustains strong partnerships that support access, care coordination, health equity, and improved outcomes for Medicaid populations.
• Represents Renown in state advisory committees, workgroups, and collaborative forums, contributing thought leadership and advancing shared Medicaid objectives.

Governance and Cross-Functional Leadership:

• Leads and coordinates internal governance structures and multidisciplinary workgroups to ensure performance across Medicaid initiatives, including financial results, utilization management, care management, quality performance, member engagement, provider access, transformation initiatives, contractual deliverables, and regulatory compliance.
• Promotes alignment, standardized workflows, and accountability across Renown entities and departments.

Population Health and Value-Based Care:

• Provides leadership in coordinating clinical, operational, and payer-aligned activities to improve health outcomes for Medicaid populations.
• Drives integration across care management, social determinants of health strategies, and community partnerships to reduce avoidable utilization and improve total cost of care performance.

Medicaid Innovation and Growth:

• Monitors national and regional Medicaid policy and market trends, educating senior leadership on emerging models, risks, and opportunities.
• Partners with executive leadership to evaluate, design, and implement Medicaid growth strategies, including product design, benefit structure, network optimization, cost management initiatives, and value-based program enhancements.

This position does not provide patient care

Disclaimer

The foregoing description is not intended to be, and should not be construed as, an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications

Requirements - Required and/or Preferred