Senior Director, Supplemental Providers – Enhanced Benefits

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage, administer, and ensure the effectiveness of supplemental vendor partnerships and enhanced benefit programs across designated markets and products.

• Develop and uphold compliant, efficient processes that align with contractual obligations, regulatory requirements, operational standards, and organizational goals.

• Formulate and lead the enterprise strategy for supplemental vendor management and enhanced/value-added Medicaid benefits across all markets.

• Assess vendor and program performance through metrics, service levels, audits, reporting, and issue escalation.

• Establish scalable governance frameworks for vendor oversight and the administration of enhanced benefits.

• Collaborate with internal departments to manage and continuously improve vendor-supported services and enhanced benefits.

• Secure pricing guardrails, actuarial inputs, and Finance approvals before sourcing or renegotiating vendor contracts.

• Review and authorize forecasts, budgets, and accrual projections for supplemental/enhanced benefit vendors.

• Collaborate with market and product leadership to design, assess, and enhance benefit offerings.

• Assist with the implementation, maintenance, optimization, operational readiness, documentation, and ongoing administration of enhanced benefits.

• Identify operational risks or deficiencies and implement corrective actions, remediation plans, or process modifications.

• Create enterprise vendor scorecards and performance management systems.

• Engage in vendor selection, contract reviews, renewals, amendments, negotiations, and RFP processes.

• Support audits, readiness reviews, corrective action plans, and responses to regulatory inquiries.

• Oversee the operational administration and performance of enhanced benefits, including OTC, nutrition, and maternal and infant support programs.

• Conduct vendor due diligence and ongoing performance evaluation.

• Ensure compliant and consistent benefit implementation while accommodating state-specific regulations.

• Monitor benefit utilization, member engagement, ROI, quality impact, and operational performance.

• Partner with analytics teams to evaluate benefit effectiveness and identify opportunities for optimization.

• Ensure compliance with Medicaid regulations, CMS requirements, state contracts, NCQA standards, delegation oversight, and privacy/data security regulations.

• Maintain accurate documentation in state filings, member materials, and operational workflows.

• Lead and develop the vendor management and enhanced benefits team.

• Create scalable processes, operational infrastructure, and talent capabilities to support enterprise growth.

• Execute other job-related duties as assigned.

⛳️ Requirements

• A Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field is required.

• A Master's degree is preferred.

• Equivalent years of relevant work experience may be considered in lieu of the required education.

• At least eight (8) years of experience leading enterprise or multi-state vendor management and/or Medicaid benefit programs within a health plan environment is required.

• A minimum of five (5) years of progressive leadership experience in Medicaid managed care, healthcare operations, vendor management, product/benefit strategy, or payer operations is required.

• Extensive knowledge of Medicaid managed care operations.

• In-depth knowledge of enhanced/value-added Medicaid benefits.

• Strong understanding of CMS and state Medicaid regulations.

• Comprehensive knowledge of delegation oversight.

• Profound understanding of managed care contracting.

• Familiarity with population health and health equity strategies.

• Knowledge of healthcare compliance, privacy, delegation oversight, and regulatory operations is essential.

• Excellent executive communication and stakeholder management abilities.

• Experience with complex vendor portfolios, contract administration, audits, and operational improvement initiatives is preferred.

• PMP certification is preferred.

• CHC and/or CHPC certification is preferred.

• Additional certifications related to managed care operations, quality, compliance, or vendor oversight are preferred.

• Ability to work in a typical office environment and remain seated or standing for extended periods.

• Up to 25% regular travel may be required.

🏝️ Benefits

• Bonus opportunities linked to company and individual performance may be available.

• A comprehensive total rewards package.

• Support for employee total well-being.

• Remote work arrangements.

• Up to 25% travel for meetings, training sessions, and conferences.