Apple Health Services and Operations Director (EMS4)

State of Washington; Olympia (WA); Hybrid; USD 150,000 - 210,000; Full time

Benefits offered by this job

Free parking

Mobile work options

Great total compensation and benefits

Job summary

State of Washington, Health Care Authority, seeks an Apple Health Services and Operations Director to lead the AHSO division, guiding 65 statewide Medicaid, CHIP, and state-funded programs serving 1.9 million residents. This division shapes policy interpretation and operational leadership across customer and provider services.

This remote-hybrid role reports to the Medicaid and CHIP Director and oversees COB and claims processing, authorization services, and related operations; onsite attendance

Qualifications

• Bachelor’s degree in health policy, health administration, public health, public administration, or related field.
• Seven (7) years of leadership experience in Medicaid, public health, human services, program administration, health policy, or related programs, projects, teams, or operations in a represented environment, and three (3) years of senior level management experience.

Responsibilities

• 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 the design, implementation, and evaluation of state Medicaid Coordination of Benefits (COB) and Third-Party Liability (TPL) policies to ensure regulatory compliance.
• Advise the Medicaid Director and Executive Leadership regarding operational impacts of policy, legislative, fiscal, and regulatory changes.
• Serve as appointing authority for a workforce of 250 employees, both represented and non-represented, through senior leaders and front-line supervisors.
• Exercise authority for personnel decisions in accordance with state laws, collective bargaining agreements, civil service rules, and agency policy.
• Direct division budget planning, resource allocation, and fiscal accountability.

Skills

Leadership

Policy interpretation

Strategic direction

Education

Bachelor’s degree in health policy/health administration/public health

Associate degree in health policy/health administration/public health

Nine years leadership experience in Medicaid/public health (represented environment)

Job description

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.

About the division:

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.

About the position:

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.

Some of what you will do:

• 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 the design, implementation, and evaluation of state Medicaid Coordination of Benefits (COB) and Third-Party Liability (TPL) policies to ensure regulatory compliance.
• Advise the Medicaid Director and Executive Leadership regarding operational impacts of policy, legislative, fiscal, and regulatory changes.
• Serve as appointing authority for a workforce of 250 employees, both represented and non-represented, through senior leaders and front-line supervisors.
• Exercise authority for personnel decisions in accordance with state laws, collective bargaining agreements, civil service rules, and agency policy.
• Direct division budget planning, resource allocation, and fiscal accountability.

Required qualifications:

Qualifying candidates will satisfy one of the following criteria options:

Option 1:

• Bachelor’s degree in health policy, health administration, business administration, public health, public administration, or other closely related field,
• Five (5) years of leadership experience in Medicaid, public health, human services, program administration, health policy, or related programs, projects, teams, or operations in a represented environment, and
• Three (3) years of senior level management experience (supervising other supervisors/managers).

Option 2:

• Associate degree in health policy, health administration, business administration, public health, public administration, or other closely related field,
• Seven (7) years of leadership experience in Medicaid, public health, human services, program administration, health policy, or related programs, projects, teams, or operations in a represented environment, and
• Three (3) years of senior level management experience (supervising other supervisors/managers).

Option 3:

• Nine (9) years of leadership experience in Medicaid, public health, human services, program administration, health policy, or related programs, projects, teams, or operations in a represented environment, and
• Three (3) years of senior level management experience (supervising other supervisors/managers).

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.
• Experience leading large-scale organizational change, systems implementation, or business transformation initiatives.
• Demonstrated executive management skills and abilities, including project management, strategic leadership, quality and system improvement, fiscal management, and management of personnel issues.
• Demonstrated knowledge of regulatory interpretation and compliance related to state and federal Medicaid and CHIP regulations
• Demonstrated ability to work with multiple stakeholders, facilitate and convene divergent groups to achieve a common goal.
• Demonstrated understanding of the complex relationships among policy, operations, technology, and customer experience and proven ability to make decisions that strengthen the overall system.
• Demonstrated knowledge and expertise with state and federal Medicaid and CHIP program rules, requirements, and regulations, as well as the evolving federal Medicaid landscape.
• Ability to lead services that are accessible, equitable, and easy to navigate, creating an exceptional customer and provider experience.
• Leading people, including managers, through coaching, mentoring, recognition, and performance feedback.
• Engaging with a diverse set of stakeholders to develop and implement policy and solve complex problems.
• Demonstrated ability to adapt and lead staff through changes within agency.
• Ability to serve as a role model for issues regarding ethical conduct and personal/professional standards.
• Interest in promoting opportunities for development and a commitment to building a diverse workforce.

Preferred qualifications:

• Master’s degree in health policy, health administration, business administration, public health, public administration, or other closely related field.
• Lean Six Sigma Green Belt certification
• Lean Six Sigma Black Belt certification
• Prosci Change Management certification
• Executive level experience in public medical assistance programs.
• Senior management level experience at a state government agency, including managing a large, complex operating budget.
• Thorough knowledge, experience and accountability in strategic leadership and planning in a complex, multi-service organization.
• Management and oversight of budgets, which include multiple sources of federal and state funds.

About HCA:

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

What we have to offer:

• Meaningful work with friendly co-workers who care about those we serve
• A clear agency mission that drives our work and is person-centered
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
• And free parking!

Notes:

Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at [e-mail]. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at 360-725-0945 or [e-mail].

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify is a registered trademark of the U.S. Department of Homeland Security.