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Medicaid Program Specialist Jobs (NOW HIRING)

Merakey

Program Specialist

Philadelphia, PA · On-site

We are seeking a Program Specialist to join our team in Philadelphia. Earn: $ 30.94/Hour + Benefits ... Supports the coordination of Medicaid renewals and redeterminations * Coordinates and facilitates ...

BerryDunn

Senior Medicaid Analyst

$87K - $109K/yr

You will work closely with program integrity leaders, forensic and payment integrity specialists, Medicaid compliance and policy experts, claims analysts, business analysts, vendors, and client ...

BerryDunn

Medicaid Payment Integrity SME

Kapolei, HI · On-site

... Program Integrity staff, audit and TPL specialists, data analysts, compliance staff, vendor ... Review Medicaid claims and medical records for accuracy, reasonableness, and compliance with ...

BerryDunn

Medicaid Payment Integrity SME

Kapolei, HI · On-site +1

... Program Integrity staff, audit and TPL specialists, data analysts, compliance staff, vendor ... Review Medicaid claims and medical records for accuracy, reasonableness, and compliance with ...

LUMA

Medical Program Specialist - MED

Coeur D Alene, ID · On-site

$27.12 - $27.70/hr

The Division of Medicaid is currently filling a Medical Program Specialist position to work in our Coeur d'Alene field office. This position will report to the Quality Assurance Supervisor, and serve ...

Kanrad

Self Direction Program Specialist

Dallas, TX

Summary As a Self-Direction Program Specialist at KanTime, you will serve as a key implementation ... This role requires deep knowledge of SDS workflows, Medicaid waivers, and program rules, combined ...

BerryDunn

Medicaid Payment Integrity SME

Kapolei, HI · On-site +1

... Program Integrity staff, audit and TPL specialists, data analysts, compliance staff, vendor ... Review Medicaid claims and medical records for accuracy, reasonableness, and compliance with ...

BerryDunn

Medicaid Payment Integrity SME

... Program Integrity staff, audit and TPL specialists, data analysts, compliance staff, vendor ... Review Medicaid claims and medical records for accuracy, reasonableness, and compliance with ...

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Medicaid Program Specialist information

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$30.5K

$67.1K

$114K

How much do medicaid program specialist jobs pay per year?

As of Sep 12, 2026, the average yearly pay for medicaid program specialist in the United States is $67,077.00, according to ZipRecruiter salary data. Most workers in this role earn between $50,000.00 and $79,000.00 per year, depending on experience, location, and employer.

What does a Medicaid Program Specialist do?

A Medicaid Program Specialist is responsible for managing, implementing, and monitoring Medicaid programs to ensure compliance with federal and state regulations. They analyze policies, oversee program operations, and help ensure that beneficiaries receive appropriate services. These specialists may also work with healthcare providers, process applications, and handle reporting or audits related to Medicaid services. Their work is essential for maintaining the quality and effectiveness of Medicaid programs.

What are the key skills and qualifications needed to thrive as a Medicaid Program Specialist?

To thrive as a Medicaid Program Specialist, you need a strong understanding of Medicaid policies, program management, and regulatory compliance, typically supported by a bachelor’s degree in public health, social work, or a related field. Familiarity with Medicaid Management Information Systems (MMIS), data analysis tools, and relevant state and federal regulations is crucial. Excellent analytical skills, attention to detail, and effective communication are vital soft skills for collaborating with stakeholders and ensuring program integrity. These abilities are essential for navigating complex healthcare regulations, optimizing program efficiency, and delivering quality services to beneficiaries.

What are some common challenges faced by Medicaid Program Specialists, and how can they be managed effectively?

Medicaid Program Specialists often face challenges such as navigating complex regulatory requirements, keeping up with frequent policy changes, and balancing the needs of diverse stakeholders. Effective management involves staying updated on federal and state Medicaid guidelines, participating in ongoing training, and fostering strong communication with healthcare providers, beneficiaries, and government agencies. Collaborating with interdisciplinary teams and utilizing robust data management systems can also help streamline processes and ensure program compliance.
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What states have the most Medicaid Program Specialist jobs?

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What are popular job titles related to Medicaid Program Specialist jobs?

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Medicaid Program Specialist jobs near you
Infographic showing various Medicaid Program Specialist job openings in the United States as of September 2026, with employment types broken down into 1% Internship, 1% As Needed, 74% Full Time, 20% Part Time, and 4% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $67,077 per year, or $32.2 per hour.

Program Specialist

Philadelphia, PA • On-site

Merakey
Non-Profits • 1 - 5K employees
Learn more about Merakeyexternal

Full-time

Medical, Dental, Vision, Retirement

Re-posted 5 hours ago

Key responsibilities

  • Coordinate program activities and ensure the delivery of high-quality services to program participants.

  • Manage and oversee individual care plans, including service plan development, implementation, and monitoring adherence to ISP.

  • Collaborate with internal and external parties to coordinate healthcare, medication oversight, and facilitate meetings such as Human Rights Meetings and assessments.

Merakey rating

6.3

Company rating: 6.3 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

Job description

Are you looking for an opportunity to advance your career while working with an extraordinary team? At Merakey, we put our heart and soul into everything we do.
We are seeking a Program Specialist to join our team in Philadelphia.
Earn: $ 30.94/Hour + Benefits
Hours: Monday-Friday 8am-4pm (40 hours)
The Program Specialist plays a critical role in the day-to-day management and oversight of specific client care within their identified Division. Reporting to the Program Director or Program Manager this position is responsible for coordinating program activities, and ensuring the delivery of high-quality services to program participants. This role may manage a caseload.
Job Functions of the Program Specialist role:
  • Overall coordination of individual care and services
  • Facilitates team meetings as needed
  • Coordinates healthcare and medication oversight
  • Is the point person and liaison with family and stakeholder contacts
  • Responsible for service plan development and implementation
  • Works with internal and external parties to ensure unit authorizations in the ISP
  • Aggregates data for quarterly reports and shares data with applicable parties
  • HRST (PA requirement) development and coordination
  • Completes and coordinates annual consents
  • Supports the coordination of Medicaid renewals and redeterminations
  • Coordinates and facilitates Human Rights Meetings (NJ) or the equivalent in other states
  • Completes the coordination the annual assessments
  • Works with business authorization and processes department on individual admissions, transfers, and discharges
  • Compiles individual specific data such as medical history, units of service, rates, staffing needs, etc. for all initial/annual pre-ISP assessments
  • Meets with Supports Coordinators (SC)/Case Manager to transfer ISP data
  • Collaborates with Behavior Specialist regarding Behavior Support Plan; submits to Peer Review; works with management regarding response and plan of action; monitors adherence to plan
  • Serves as a resource for Program Manager in determining activities in immediate neighborhoods in which Individuals can participate to foster inclusion
  • Participates in the development of Supports Intensity Scale (SIS)
  • Analyzes daily, weekly, monthly, progress notes and data collection tools to verify adherence to ISP; determines any changes needed or inconsistencies in services provided; and initiates changes as appropriate
  • Ensures Peer Review recommendations are implemented by Manager regarding Consumer Behavior Plans
  • Initiates Consumer burial reserve account; works with Fiscal Department to manage accounts to include Special Needs Trusts
  • Conducts audits to ensure compliance with licensing regulations
  • Collaborates with Nursing to address Consumer healthcare issues, prescribed medications, discharge instructions, Consumer-specific adaptive equipment needs, and delivery of Individual -specific training
  • Provides follow-up regarding medical appointments, cancelled appointments, transportation, and medical refills, etc.
  • Complies with Incident management policy and procedures to include any necessary follow-up

Benefits
Merakey offers generous benefits that promote well-being, financial security, and work-life balance, including:
  • Comprehensive medical, dental, and vision coverage, plus access to healthcare advocacy support.
  • Retirement plan -- both pre-tax and Roth (after-tax) options available for employee contributions.
  • DailyPay -- access your pay when you need it!
  • On the Goga well-being platform, featuring self-care tools and resources.
  • Access Care.com for backup childcare, elder care, and household services.
  • Confidential counseling, legal, and financial services through our Employee Assistance Program (EAP).
  • Tuition reimbursement and educational partnerships.
  • Employee discounts and savings programs on entertainment, travel, and lifestyle.
  • Access to Pryor Online Learning for free online personal development classes.

Learn more about our full benefits package - https://www.merakey.org/careers/benefits
About Merakey
Merakey is a non-profit provider of developmental, behavioral health, and education services. More than 8,000 employees provide support to nearly 40,000 individuals and families throughout 12 states across the country each year. Click here to watch a video about Merakey. Merakey strictly follows a zero-tolerance policy for abuse.
Merakey is proud to be an Equal Opportunity Employer! We deeply value diversity and do not discriminate on the basis of race, religion, color, national origin, ethnic background, sex, gender, gender identity, sexual orientation, age, marital status, veteran status, genetic information, or disability status. Moreover, we are committed to creating teams that reflect the diversity of the communities we serve and encourage applicants from underrepresented backgrounds to apply. Merakey welcomes all Veterans to apply!
The ideal candidate will possess the following qualifications:
  • Bachelor's Degree or 60 credit hours in place of education
  • 3-5 total years of experience
  • 1-3 total Supervisory/Managerial experience
  • NADD Certification required within 1 year of hire
  • Certified Technology Assessor Preferred
  • HRST Reviewer completion within 1 year of hire

What Merakey employees say

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About Merakey

Sourced by ZipRecruiter

Merakey is a leading developmental, behavioral health, and education non-profit provider with a fifty-year history. We offer a breadth of integrated services to individuals and communities across the country. Our belief that every individual has the right to achieve growth, dignity, and fulfillment guides all of our decisions. At Merakey, we care about each other and are committed to providing the very best care to those we serve. Merakey strictly follows a zero-tolerance policy for abuse.

Industry

Non-profits

Company size

1,001 - 5,000 Employees

Headquarters location

Lafayette Hill, PA, US

Year founded

1960

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