Program Delivery Lead

** Become a part of our caring community*
* The Program Delivery Lead will lead the strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs. This leader will partner across Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors to ensure members receive benefits for which they qualify while maximizing appropriate reimbursement and revenue opportunities.

The role is accountable for program performance, market expansion, vendor governance, stakeholder alignment, and the delivery of measurable financial and operational outcomes. The successful candidate will be an expert at navigating complex Medicaid environments, influencing across matrixed organizations, and translating strategic opportunities into scalable operational solutions.

The Program Delivery Lead will lead the strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs. This leader will partner across Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors to ensure members receive benefits for which they qualify while maximizing appropriate reimbursement, revenue, and cost-of-care opportunities.

The role is accountable for program performance, market expansion, vendor governance, stakeholder alignment, and the delivery of measurable financial and operational outcomes. The successful candidate will be an expert at navigating complex Medicaid environments, influencing across matrixed organizations, and translating strategic opportunities into scalable operational solutions.

** Key Responsibilities*
* ** Revenue Optimization Program Leadership*
* + Lead Medicaid revenue optimization initiatives including but not limited to:

+ SSI eligibility identification and conversions

+ ESRD Medicare and non-dual to dual transitions

+ Member activation and engagement initiatives

+ Condition based solutions

+ Develop and execute multi-year program roadmaps aligned with organizational growth objectives.

+ Identify opportunities to improve program performance, financial outcomes, and member engagement and experience.

+ Monitor leading and lagging indicators to proactively manage business performance.

** Operational Execution*
* + Oversee end-to-end program delivery from strategy through implementation and ongoing operations.

+ Establish operational frameworks, governance structures, KPI reporting, and performance management processes.

+ Remove barriers impacting outreach effectiveness, encounter acceptance, provider documentation, and vendor execution.

+ Ensure program scalability across multiple Medicaid markets.

** Cross-Functional Leadership*
* + Build strong partnerships across:

+ Finance

+ Clinical and Care Management

+ Compliance

+ Procurement

+ Member and Provider Engagement

+ Encounters Operations

+ Medicaid Market Leadership

+ Actuarial

+ Facilitate executive-level discussions regarding performance, opportunities, and risk mitigation.

+ Drive accountability across stakeholders to meet program objectives.

** Vendor Management*
* + Lead strategic vendor relationships supporting member engagement and revenue optimization initiatives.

+ Establish performance standards and monitor contractual outcomes.

+ Evaluate vendor capacity, quality, operational efficiency, and financial value realization.

+ Partner with vendors to develop innovative approaches to improve member activation and program completion rates.

** Financial Performance Management*
* + Quantify business opportunities and expected financial outcomes.

+ Develop business cases and ROI analyses for program enhancements and market expansions.

+ Monitor revenue realization, cost structures, forecast performance, and financial risks.

+ Present performance updates and recommendations to executive leadership.

** Market Expansion & Innovation*
* + Support introduction of programs into new Medicaid markets.

+ Navigate state-specific regulatory requirements and approval processes.

+ Evaluate emerging revenue optimization opportunities and new member engagement strategies.

+ Drive continuous improvement and innovation initiatives.

** Preferred Competencies*
* ** Strategic Leadership*
* + Creates long-term strategies while maintaining operational rigor.

+ Balances member experience, regulatory requirements, and financial performance.

** Program Management Excellence*
* + Expert knowledge of large-scale program delivery methodologies.

+ Demonstrated success managing complex, cross-functional initiatives.

** Financial Acumen*
* + Strong understanding of:

+ Medicaid financing

+ Revenue optimization

+ Business case development

+ Forecasting and ROI analysis

** Influencing & Executive Presence*
* + Ability to influence without direct authority.

+ Comfortable leading discussions with senior executives and market leadership.

** Data-Driven Decision Making*
* + Uses analytics to identify opportunities and drive…