Eligibility Policy Program Manager (HCPM/AHEA)
Washington State Health Care Authority
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Descripción de la vacante
Washington State Health Care Authority is seeking an Eligibility Policy Program Manager (Health Care Program Manager) to lead statewide Apple Health renewal policy and change of circumstances across 65 programs. This remote role may require occasional in-person meetings; Washington residency is required on first day.
You will translate federal/state requirements into practical policy, manage partnerships with federal and tribal partners, and drive improvements in eligibility determinations while
Formación
- Knowledge of health care delivery systems, public health programs, and applicable federal/state requirements.
- Experience developing, implementing, monitoring, evaluating health care programs and policies.
- Ability to interpret laws, admin rules, policies, contracts in complex issues.
- Skill in analyzing data, assessing risks, and recommending actions.
- Experience building productive relationships with agencies, providers, community orgs.
- Ability to communicate complex policy clearly to leadership, staff, partners.
- Understanding barriers to health care access and equity in service delivery.
- Experience coordinating cross-functional activities and setting priorities.
- Sound judgment in resolving complex program concerns and improving workflows.
Responsabilidades
- Serve as SME in Apple Health eligibility renewal policy and change of circumstances.
- Collaborate with federal and state partners to implement initiatives affecting renewal cycles.
- Lead workgroups to develop eligibility processes compliant with policy.
- Coordinate CMS meetings to ensure Medicaid policy compliance.
- Translate federal policy into statewide Apple Health policy and WA Code development.
- Lead partner relations to implement changes with federal partners and tribal partners.
- Respond to legislative inquiries and assess potential impact on Apple Health.
- Direct policy implementation and act as regional contact for guidelines.
- Analyze agency policy, develop proposals, and improve case processing workflows.
- Train staff and partners on Apple Health policy via webinars and meetings.
Conocimientos
Educación
Herramientas
Descripción del empleo
This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs.
All HCA employees are required to be Washington state residents upon their first day of employment.
Be the agency's go-to expert on how Washington residents keep their Apple Health coverage. As the Eligibility Policy Program Manager in the Eligibility Policy Innovation and Community Support (EPICS) section, you will lead statewide policy for Apple Health renewals, ex part renewal , and change of circumstances across all 65 programs. You will translate federal and state requirements into clear, workable policy that protects coverage for nearly 2 million Washingtonians and ensures state and federal funds are used appropriately.
- Serve as the subject matter expert in Apple Health eligibility renewal policy, ex part renewal , and change of circumstances, leading the analysis and maintenance of current and changing policy across all 65 programs with working knowledge of all statewide Apple Health eligibility policy.
- Collaborate with federal partners, community partners, staff, and system partners to build shared understanding and implementation of initiatives that impact renewal cycles and compliance.
- Coordinate and lead workgroups with business partners to develop eligibility processes that comply with federal and state policy.
- Coordinate monthly Centers for Medicare & Medicaid Services (CMS) meetings to ensure HCA follows Medicaid and Title XXI/CHIP requirements.
- Translate federal policy and guidance into statewide Apple Health policy through Washington Administrative Code (WAC) development and adoption; develop and clarify policy and procedures for legislative staff, constituents, state agencies, HCA staff, and community-based organizations.
- Lead and manage partner relations to implement necessary changes with federal partners, community assisters, providers, legal advocates, Tribal partners, and other interested parties.
- Respond to legislative and constituent inquiries and review legislative bills with potential impacts to Apple Health, making recommendations consistent with strategic long‑and‑short‑range plans.
- Direct the implementation of policy, negotiate with partners on behalf of the agency, and serve as a regional point of contact on policy and implementation guidelines.
- Analyze agency policy and operations, develop proposals for executive management, and lead improvements to case processing, workflows, and eligibility determinations.
- Train staff and community partners on Apple Health policy and present to partners and leadership through webinars, meetings, and conference calls.
- Your expertise will directly protect continuous health coverage for Washington residents at every renewal.
- You'll work at the intersection of federal guidance, state rulemaking, and community implementation.
- You'll have real influence, presenting proposals to executive leadership and shaping statewide policy.
- You'll collaborate with CMS, partner agencies, Tribal partners, and community organizations across the state.
You are a policy expert who can untangle complex federal and state requirements and turn them into clear, practical guidance. You think strategically about long‑and‑short‑range plans while staying responsive to day‑to‑day issues, and you resolve complex problems independently while knowing when to involve leadership. You are a confident communicator and negotiator who builds trust with partners, uses human‑centered design, and applies an equity lens to policy development.
Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter, resume, and application.
- Health Care Program Knowledge:Demonstrated knowledge of health care delivery systems, public health programs, and applicable federal and state requirements to support effective program administration.
- Program Planning and Implementation:Demonstrated experience developing, implementing, monitoring, and evaluating health care programs, policies, and operational initiatives to achieve established objectives.
- Policy and Regulatory Interpretation:Demonstrated expertise interpreting and applying laws, administrative rules, policies, and contractual requirements to complex program issues.
- Strategic Analysis and Decision‑Making:Demonstrated skill in analyzing program data, assessing risks and operational impacts, and developing informed recommendations for management decisions.
- Partner Collaboration:Demonstrated experience establishing and maintaining productive relationships with agencies, health care providers, community organizations, and other partners to advance shared program goals.
- Communication and Consultation:Demonstrated skill in communicating complex health care program information clearly and providing sound technical guidance to leadership, staff, and external partners.
- Equitable Service Delivery:Demonstrated understanding of barriers to health care access and approaches that support responsive, inclusive, and culturally appropriate services.
- Leadership and Organizational Coordination:Demonstrated experience coordinating cross‑functional activities, setting priorities, and supporting staff and partners through operational or policy changes.
- Problem Resolution and Continuous Improvement:Demonstrated sound judgment in resolving complex program concerns, balancing competing priorities, and implementing practical improvements consistent with program requirements.
- Equity lens – All HCA employees are required to consider equity in their decisions, processes, and day‑to‑day work, including how their work may affect the people and communities we serve.
- The ability to take action to learn and grow – You take action to learn and grow by seeking new perspectives, learning from experiences, and using what you’ve learned to continuously improve how you work and serve others.
- The ability to take action to meet the needs of others – You take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve.
While these are not required, having them may help you stand out as an applicant.
- Demonstrated professional experience providing consultation or supervision in health services, social services, Medicaid, behavioral health, or other health care programs.
- Effective written and verbal communication skills, including public speaking, partner engagement, leadership, strategic planning, project management, and independent decision‑making when interacting with agency leadership, professional organizations, community partners, and other interested parties.
- Demonstrated knowledge of Washington State government structure, agency functions, and Apple Health (Medicaid) policies, procedures, and services to support effective administration and delivery of medical assistance programs.
- Experience interpreting and applying state and federal laws, regulations, policies, and procedures governing Medicaid, health care reform, and the administration and delivery of medical assistance programs.
- Experience researching, developing, drafting, and evaluating Medicaid policies and procedures; analyzing policies and practices in other states; developing short‑and‑long‑term program strategies; and assessing program implementation for compliance with applicable legal and regulatory requirements.
- Experience conducting complex research and analysis of Medicaid systems, program data, legislation, fiscal constraints, and other relevant information to identify issues, evaluate alternatives, and recommend solutions related to Medicaid and state‑funded medical program eligibility policies.
- Experience developing and delivering educational materials, presentations, and technical guidance regarding federal Medicaid and state‑funded medical program eligibility policies and services to community organizations, partners, legislators, and other audiences.
- Demonstrated proficiency in management principles, organizational practices, collaborative problem‑solving, conflict resolution, negotiation, and decision‑making to support effective program operations and organizational objectives.
- Demonstrated proficiency in Microsoft Office applications, databases, spreadsheets, and information management systems, including ACES, Barcode, ProviderOne, Washington Healthplanfinder, and other relevant systems to research, analyze, and manage program information.
- A master’s degree in public health, behavioral health, public administration, business administration, social work, or a closely related field.
The Apple Health Eligibility and Access (AHEA) Division works across HCA and in partnership with the health care community at the local, state, and federal levels to develop and manage high‑quality, evidence‑based health care programs and purchase services that enhance Washington residents' ability to access appropriate, quality health care. Within AHEA, the Eligibility Policy Innovation and Community Support (EPICS) section evaluates federal statutes and regulations, sets state policy for Apple Health eligibility, and represents the agency in communities across the state, supporting the nearly 2 million Washington residents who rely on Apple Health for affordable medical services.
Better Health. Better Care. A Healthier Washington.
At HCA, we work to ensure people across Washington have the opportunity to be as healthy as possible. As the State’s largest health care purchaser and behavioral health authority, HCA serves nearly 3 million Washington residents through Apple Health (Medicaid), Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs, and behavioral health services. Through this work, HCA purchases and coordinates care coverage, supports behavioral health prevention, treatment, crisis response, and recovery and helps strengthen access to high‑quality care across Washington.
We want our employees to have the support, flexibility, and benefits they need to do their best work and build a career that works for their life. As a Washington State HCA employee, you’ll have access to a comprehensive benefits package that supports your health, financial well‑being, and work‑life balance. Our benefits are designed to support you today while helping you plan for future. Learn more about why HCA by visiting Voices of HCA and the "Who we are" section of our website.
- Remote work and flexible schedules
- Medical, dental, vision, and basic life insurance
- Paid vacation, sick leave, and 12 paid holidays
- Paid Family and Medical Leave (PFML)
- Retirement options to plan for the future
- Training and professional development opportunities
- Employee wellness programs
- Learn more about Washington State Employee Benefits
This is a full-time 40‑hour-per‑week remote position. Our standard business hours are Monday through Friday, 8 a.m. to 5 p.m., with alternative work schedules considered based on business needs and supervisor approval. In this role you will regularly collaborate with colleagues, agency leaders, state and federal partners, and other external partners or customers. Occasional travel may be required for meetings, training, or other business needs. All employees are required to report to our Olympia office on their first and final day of employment.
The Health Care Authority is an equal opportunity employer. We are committed to creating a workplace where employees are respected, included, and supported in bringing their experiences, perspectives, and ideas to work. Our commitment to inclusion is reflected in how we work together and serve the people of Washington. HCA also supports five voluntary employee led Employee Resource Groups (ERGs), which create opportunities for connection, community, learning, and professional growth.
If you have questions, need assistance with the application process, require an accommodation, or would like to request this posting in an alternative format, please contact Lisa Fleming, Human Resource Consultant (Recruiter) at HCAjobs@hca.wa.gov and reference the recruitment title and job number in the subject line.
Reach out to NEOGOV directly at 1-855-524-5627 for technical support and login issues.
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.
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