Careers

The California Department of Health Care Services (DHCS) is seeking a skilled innovative leader with extensive experience in audits, investigations, and compliance to fill the role of Deputy Director (DD), Audits and Investigations (A&I).

The DD, A&I leads all aspects of specified DHCS A&I functions, which include but are not limited to investigations, financial audits, and reviews of Departmental programs and expenditures. The DD, A&I also serves as an advisor to the Director and Executive staff in matters of extreme sensitivity to the Department, its programs, and its provider and client communities. Additionally, the DD, A&I, leads subordinate team members at the Executive level and below to carry out A&I functions in the Contract and Enrollment Review, Financial Review Inpatient, Financial Review Outpatient and Behavioral Health, and Investigations Divisions. The DD, A&I, builds collaborative working relationships with internal and external partners and stakeholders, including but not limited to, the California Health and Human Services Agency (CalHHS), the California Department of Justice (DOJ), the Governor’s Office, the state Legislature, and other state, federal, and local representatives. The DD, A&I, works under the general direction of the Chief Deputy Director, Policy and Program Support and is a member of the DHCS Executive Staff.

Learn more and apply here: CalCareers

Core Responsibilities:

The Medicaid Management Information System (MMIS) Associate Director provides business systems and technical leadership for Maine Integrated Health Management Solution (MIHMS) and other components of the Medicaid Enterprise System (MES). (Please see the Agency Information section below for more information.)

The position oversees critical technology systems and associated vendors, supports the Office of MaineCare Services (OMS) to appropriately understand and plan for the impacts of large systems implementations, and drives MaineCare to continually look for ways to strategically improve its systems in ways that benefit staff, members, and providers in alignment with MaineCare’s priorities. The position will supervise and provide leadership direction to 2-3 direct reports and 14-15 indirect reports and will work highly collaboratively with MaineCare’s fiscal agent to ensure that teams are aligned with OMS and the Department of Health and Human Services (DHHS) business needs and priorities.

This position will be a member of the OMS Senior Management Team. In that capacity, the position will serve as a senior level liaison to other teams within and outside OMS, promote cross-team collaboration and communication, lead complex technology-related initiatives, contribute to budget and legislative planning, advise senior and executive leaders on MES topics and issues, and provide updates on project progress and advancements of key priorities. To accomplish this, the person in this position must understand how the teams’ work is connected to the work of other teams within OMS and other state agencies. As a senior leader within the office, this position must be able to understand, professionally and confidently represent, and promote the work, values, and priorities of the division, Office, and Department to both internal and external audiences. The person in this position must be able to think critically and creatively, be solution-oriented, take a high degree of initiative, show good judgment, and work under minimal supervision.

For more information and how to apply, click here.

Description

Make a meaningful impact in the lives of vulnerable Americans who need long-term care by embracing this exciting opportunity. The WA Cares Fund is a first-in-the-nation program. Created by the WA State Legislature in 2019, the WA Cares Fund (WCF) offers affordable long-term care insurance coverage to all working Washingtonians.

The WA Cares Fund is part of DSHS’s Home & Community Living Administration (HCLA). WA Cares is going live with statewide benefit implementation this summer. At the same time, this hire is the beginning of our efforts to develop a plan to implement out-of-state benefits effective July 1, 2030.

The Portability Administrator will design and launch the out-of-state benefits model that will allow WA Cares participants to access benefits across the country—and ultimately around the world. This role is built for a senior leader who has experience architecting complex programs across jurisdictions, enjoys working in uncharted policy and operational territory, and wants to shape a model that could influence public benefit design nationally.

Reporting directly to the WA Cares Fund Director and serving on the division’s senior leadership team, the WCF Portability Administrator leads the end-to-end design and implementation of the WA Cares Fund out-of-state benefit portability program, with benefits scheduled to go live for out-of-state participants on July 1, 2030.

As the Portability Administrator, you will own the portability strategy and roadmap, from policy design and legislative alignment to financial planning, technology integration, interstate agreements, and partner strategy. You will have substantial influence on service continuity for participants living outside Washington, as well the long-term credibility of WA Cares Fund as the nation’s first publicly funded long-term care social insurance program. Because the work is highly visible and has no direct U.S. precedent, it requires a leader who is comfortable making thoughtful, evidence-based decisions in an emerging field.

Through strong executive communication, comfort working across agencies and sectors, and a visible commitment to equity, diversity, and inclusion in both program design and service delivery, you will bring the ability to lead multi-year initiatives from concept to launch, translate legislation and policy into clear implementation frameworks, manage budgets of $1 million or more, and synthesize complex legal, actuarial, and operational information into actionable decisions.

For more information and how to apply, click here.

Summary

This position is located in the Center for Medicaid and CHIP Services (CMCS), Office of the Center Director, Disabled & Elderly Health Programs Group, Centers for Medicare and Medicaid Services (CMS).As Director of the Medicaid Benefits and Health Program Group, you will lead national Medicaid policy and operations for benefits, coverage, pharmacy programs, the Medicaid Drug Rebate Program, and long-term services and supports, including home and community-based services.

Duties

• Develops, monitors, and evaluates regulations, policies, procedures, and other guidelines for States in the design and implementation of their Medicaid programs in key program areas and provides technical assistance to support states.
• Develops and monitors Medicaid pharmacy policy, including the Medicaid Drug Rebate Program, classification of drugs, Federal Upper Limits, drug utilization review, prior authorization, Federal offsets/recapture, and preferred drug lists.
• Establishes, implements, and oversight for the Medicaid program policy for the Health Homes, and Program for All Inclusive Care for the Elderly (PACE) programs.
• Reviews, and approves, benefits/coverage and State Plan Amendments, and 1915(c) waivers.
• Administers and monitors systems transformation grants, including Money Follows the Person. Assists the States in the design and implementation of their community-based long-term care support systems.
• Establishes policy regarding program monitoring, performance management, quality improvement, and consumer protections for programs and services administered by MBHPG.
• Leads national Medicaid benefits and coverage policy, including behavioral health, long-term supports, home health, and clinical care.
• Provides national leadership on the development and management of Medicaid program policy related to benefits and coverage. To include mental health, substance use disorder services, long-term supports, home health, and clinical/facility care, ect.

For more information and how to apply, click here.