Director, Medicaid & Managed Care Strategy

State-of-South-Carolina; South Carolina; On-site; USD 140,000 - 210,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Paid time off

Paid holidays

Parental leave

Job summary

The SC Department of Behavioral Health and Developmental Disabilities (BHDD) seeks a Director of Managed Care to lead Medicaid and managed care activities, serving as Finance’s SME and liaison with SCDHHS. This role drives policy, reimbursement, enrollment, and revenue cycle operations across BHDD functions.

Responsibilities include overseeing contracting, auditing responses, and providing executive-level reporting.

Qualifications

• Extensive knowledge of Medicaid reimbursement, policy, managed care, and healthcare payer operations.
• Significant experience with Medicaid and Medicaid managed care.
• Experience with state Medicaid agencies or Medicaid managed care organizations.
• Experience in behavioral health, developmental disabilities, hospital, or large healthcare delivery systems.
• Experience with Medicaid reimbursement methodologies, payer contracting, provider enrollment, and revenue cycle operations.
• Prior supervisory or leadership experience.

Responsibilities

• Develop and maintain subject matter expertise on South Carolina Medicaid programs relevant to BHDD services and monitor policy changes.
• Serve as primary Finance liaison with SCDHHS and Medicaid managed care organizations; coordinate payer-related issues.
• Coordinate managed care contracting, amendments, and enrollment requirements with Legal and senior leadership.
• Evaluate reimbursement methodologies and develop financial analyses related to Medicaid, payer changes, and policy changes.
• Maintain executive dashboards on enrollment, payer participation, and financial risks; advise senior leadership.
• Coordinate responses to Medicaid and managed care audits and data requests; establish standardized processes across BHDD.

Skills

Medicaid knowledge

Negotiation

Communication

Presentation

Relationship management

Education

Master’s degree in business/healthcare/finance/public administration

Job description

The SC Department of Behavioral Health and Developmental Disabilities (BHDD) seeks a Director of Managed Care to lead Medicaid and managed care activities, serving as Finance’s SME and liaison with SCDHHS. This role drives policy, reimbursement, enrollment, and revenue cycle operations across BHDD functions.

Responsibilities include overseeing contracting, auditing responses, and providing executive-level reporting.