Director ​/ Senior Director, Medicaid Operations & Automation

Director / Senior Director of Medicaid Revenue Optimization & Automation

As Director / Senior Director of Medicaid Revenue Optimization & Automation, you will lead the transformation of Medicaid rebate operations by leveraging advanced technology, process automation, and data-driven strategies. Your mission is to drive operational excellence, eliminate revenue leakage, and ensure seamless dispute resolution, with a strategic focus on optimizing both generic and branded pharmaceutical portfolio operations. You will ensure that all assigned State Medicaid rebate programs fully comply with CMS and other regulatory requirements, and that all program activities are actively monitored, well-staffed, and effectively communicated across the organization.

Position is based in Parsippany, New Jersey; remote candidates may be considered based on business needs, with East Coast location preferred.

• Regulatory Compliance & Program Oversight:
Ensure each assigned State's Medicaid rebate program adheres to all CMS and applicable federal/state requirements. Actively monitor federal and supplemental rebate programs, maintain appropriate staffing levels, and oversee comprehensive training for Medicaid analysts.

• Technology-Driven Process Leadership:
Champion the adoption of cutting-edge automation tools (AI, Bots) to streamline Medicaid rebate processing, data validation, and reporting. Continuously assess and implement digital solutions to enhance accuracy, speed, and scalability, including the use of Model N's Flex system for Medicaid adjudications.

• Project Management & Innovation:
Lead cross-functional projects to re-engineer Medicaid processing workflows, integrating best practices in project management to deliver measurable improvements in cycle time, compliance, and cost efficiency. Foster a culture of innovation and continuous improvement by identifying emerging opportunities and piloting new approaches to enhance operational performance.

• Revenue Integrity & Leakage Prevention:
Design and implement robust controls and analytics to proactively identify and prevent revenue leakage across all Medicaid transactions. Develop dashboards and exception reporting to monitor trends, root causes, and corrective actions.

• Strategic Dispute Resolution:
Oversee the end-to-end dispute management process, utilizing advanced analytics and automation to resolve claim discrepancies efficiently. Collaborate with state agencies and internal teams to ensure timely, data-backed resolutions and minimize outstanding balances.

• Effective Medicaid Operations:
Support the adjudication, validation, and dispute resolution of Medicaid rebates for both generic and branded pharmaceutical products, with increased attention to the complexities and compliance requirements of branded products. Ensure all claim processing and dispute activities are executed with precision, in alignment with regulatory standards and internal controls, while collaborating with relevant teams to address product-specific issues as they arise.

• Stakeholder Alignment & Engagement:
Maintain close alignment with internal and external stakeholders, including state agencies, finance, value & access, IT, and compliance, to ensure seamless Medicaid operations. Stay continuously informed on all relevant government legislation, program guidance, and any new contracts or amendments, promptly updating processes and communicating changes. Facilitate clear, timely communication and collaborative problem-solving to support compliance and operational excellence.

• Training, People Development & Collaborative Culture:
Lead comprehensive training and development programs to ensure team members possess the latest knowledge and skills in Medicaid rebate adjudication, claim validation, and dispute resolution. Champion a culture of continuous learning, open communication, and mutual respect, encouraging team members to share ideas, raise concerns, and collaborate freely. Promote professional growth and cross-training, empowering staff to adapt to evolving processes and technologies while supporting each other's success.

• Team Leadership & Management:
Manage and mentor a large…