Senior Director, Eligibility Excellence
Skills
- Deep knowledge of federal and California Medicaid policy and Medicare eligibility pathways
- Expertise in eligibility operations, redetermination, asset testing, and institutional deeming
- Experience designing scalable systems and operational workflows
- Data-driven performance management and KPI/dashboard development
- Cross-functional stakeholder management and regulatory relationship building
- People leadership, hiring, and talent development
Responsibilities
- Design and implement a scalable Eligibility Center of Excellence (CoE) covering policy, segmentation, and end-to-end workflows
- Oversee daily eligibility operations including redeterminations, share-of-cost, financial assistance consulting, reconciliation, and participant communications
- Establish and manage KPIs, dashboards, and audit routines to measure performance, monitor regulatory risk, and drive continuous improvement
- Build, hire, coach, and develop a high-performing team of managers and front-line staff to meet organizational goals
- Serve as executive escalation point for complex eligibility cases and collaborate with cross-functional leaders to resolve access and compliance risks
- Partner with Enrollment, Finance, Operations, and Compliance to remove barriers and ensure timely, compliant coverage for participants
- Lead enterprise enablement through SOPs, training programs, and knowledge base management
Education
- Bachelor's degree required
- Master's degree in Public Health, Health Administration, Public Policy, or related field preferred
Benefits
- Medical, Dental, Vision insurance
- 17 days PTO, 12 observed holidays, 6 sick days
- 401(k) with employer match
- Competitive base pay, annual bonus, and equity
- Comprehensive total rewards package and additional benefits
Average salary estimate
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