Medical Program Manager Jobs in Cleveland, MS (NOW HIRING)

RECRUITMENT REPOST. PREVIOUS APPLICANTS NEED NOT REAPPLY.

25

MDH Office of Health Care Financing, Baltimore MD

The main purpose of this position is to supervise and manage the Office of Eligibility Services (OES) within the Health Care Financing & Medicaid Administration, helping to ensure that Marylanders receive efficient and accurate eligibility services. This role is responsible for overseeing the eligibility operations, systems, regulation and policy, and staff for Medicaid, Maryland Children’s Health Insurance Program (MCHP), and other Medical Assistance Programs. This position directs the implementation and continuous improvement of eligibility operations, including policy development, system functionality, and eligibility caseworker training programs. This work crosses the Maryland Health Benefits Exchange, Department of Human Services, and local health departments. The Director is also responsible for maintaining strong operational performance standards that ensure eligibility and frontline staff effectively support Marylanders as they enroll in and renew coverage. Key operational responsibilities include overseeing the development, implementation, and maintenance of eligibility operations, regulations, and policies under the Code of Maryland Regulations (COMAR). This role also involves leading the design and delivery of statewide eligibility training and technical assistance programs for eligibility case workers across the Maryland Department of Health, local health departments, the Department of Human Services, and the Maryland Health Benefit Exchange. Additional responsibilities include ensuring the accuracy, integrity, and operational functionality of the master eligibility file and supporting the Medicare Part B Buy-In program. The position also manages the issuance of Medical Assistance identification cards and related customer service processes, oversees eligibility determinations for specialized programs such as Home and Community-Based Services (HCBS) waivers, and implements operational improvements that enhance efficiency, accuracy, and member satisfaction. Functional leadership responsibilities include supervising and developing OES staff to strengthen operational execution and service excellence, as well as serving as a liaison with state and federal partners to coordinate eligibility operations and resolve recipient issues. The role also includes providing legislative testimony and supporting executive decision-making through operational data and analysis. Additionally, the position collaborates with CMS and internal technical groups, including the Medical Assistance Advisory Committee and the MCO rate setting workgroup to align eligibility operations with broader program goals.

Qualified candidates must possess a bachelor's degree from an accredited college or university and six years of experience in large-scale program administration, operations, or change management, preferably in health care, Medicaid, or eligibility programs. A minimum of three years at a supervisory or management level is also required. Qualifying supervisory experience must include leading complex, broad-scope organizational or operational change in one or more of the following areas: healthcare administration, government program operations, or eligibility systems management. Familiarity with Medicaid programs, Medical Assistance eligibility determination, or related policy and regulatory frameworks is strongly preferred. A Master's degree is preferred and will substitute for one year of general experience. A Doctorate will substitute for two years of general experience.

The desired candidate should possess the following:

• Extensive experience managing large-scale eligibility or public benefits operations, ideally within Medicaid, health coverage, or other human services programs.
• Proven leadership in operational management, including overseeing staff, performance, workflow, and service delivery systems.
• Experience improving customer service systems and processes, with a focus on member experience, accessibility, and efficiency.
• Strong understanding of eligibility policy, systems, and regulations, including how policy changes translate into operational implementation.
• Experience coordinating across multiple agencies or partners, such as human services departments, health exchanges, or IT system vendors.
• Background in training and workforce development, ensuring consistent understanding and application of eligibility policies statewide.
• Demonstrated ability to use data and performance metrics to manage operations, improve accuracy, and enhance customer satisfaction.
• Familiarity with federal and state Medicaid requirements, including reporting, compliance, and quality standards.