Apple Health Services and Operations Director; EMS

Apple Health Services and Operations Director

This is a remote-hybrid position with onsite work required as needed to support business operations.

This position provides policy and operational leadership for customer- and provider-facing units doing critical work to directly support Washingtonians every day. This division leader is a mix of Medicaid policy interpretation and implementation as well as operational leadership of units that include both union represented and non-represented staff. If you’re drawn to a leadership opportunity that is close to the people you serve, this is the opportunity for you!

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

Washington State's Medicaid program is branded as Washington Apple Health (or simply Apple Health). The Apple Health Services and Operations (AHSO) division consists of the Medical Assistance Customer Service Center (MACSC), Coordination of Benefits and Claims Offices (COBCO), Provider Enrollment (PE), and Authorization Services Office (ASO). This position reports directly to the Medicaid and CHIP Director and plays a vital role in accomplishing the Health Care Authority’s mission.

HCA promotes health care access to the uninsured, underinsured, and Tribes; it ensures that health technology and prescription drugs are safe and used effectively, and improve health and productivity of state employees, retirees, and their dependents. HCA’s mission is powered by the people we serve; we improve health across Washington by advancing equitable access to quality, whole-person care.

The Assistant Director leads the AHSO division, providing executive leadership, strategic direction, and operational oversight of customer and provider services for 65 statewide Medicaid, CHIP, and state-funded medical assistance programs serving 1.9 million Washingtonians and the newly launched WACares program. The position is responsible for ensuring the effective administration of customer contact center services, provider enrollment, coordination of benefits, fee-for-service claims processing, authorization services, and related operational functions that support access to care and payment for health services.

This position is eligible for remote work but is required to report on-site at least two times per week to meet business need. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs.

All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment, regardless of telework status or location.

• Direct statewide customer and provider service operations for Medicaid, CHIP, state-wide medical assistance programs, and the WACares Program.
• Establish strategic direction, priorities, performance measures, and operational objectives for AHSO units.
• Ensure operational excellence and lead enterprise-wide initiatives to improve customer service delivery, provider support, and claims administration.
• Ensure operational readiness for major program, policy, and systems changes.
• Provide executive oversight and direction for Medicaid program administration, compliance, and policy interpretation, operationalization, and compliance.
• Address federal and state statutes, regulations, CMS guidance, audit findings, and program requirements related to Medicaid prior authorization, coordination of benefits, and provider enrollment.
• Direct…