MEDICARE-MEDICAID INTEGRATION PROGRAM LEAD

State of New Hampshire

New Hampshire

On-site

USD 104,000 - 127,000

Full time

14 days+

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Benefits offered by this job

Dental Plan

Flexible spending accounts

Retirement plan

Wellness program

Paid holidays & leave

Job summary

State of New Hampshire is seeking a Medicare-Medicaid Integration Program Lead to administer Medicare-Medicaid integration initiatives within GO-NORTH and the Division of Medicaid Services (DMS). The role focuses on D-SNPs, Medicare Advantage coordination, and program operations to improve beneficiary care coordination and program accountability.

The position directs cross-departmental teams, ensures regulatory compliance, and reports progress to leadership.

Qualifications

Bachelor’s Degree required.
At least three years of relevant experience including Medicaid or Medicare policy and managed care.
Experience overseeing health care programs and contracts is preferred.

Responsibilities

Directs development, implementation, and evaluation of Medicare-Medicaid integration initiatives and ensures alignment with state and federal requirements.
Leads planning and day-to-day program management, including timelines, milestones, and risk mitigation.
Oversees development and oversight of SMAC contracts, policies, and reporting related to D-SNPs and integrated care models.
Manages enrollment, benefit coordination, and program oversight to minimize gaps and ensure seamless coordination across programs.
Serves as primary GO-NORTH contact for external stakeholders including plans, providers, and CMS.
Monitors outcomes, enrollment trends, quality performance, and member experience, and reports to leadership.

Skills

Verbal and written communication

Medicare/Medicaid policy

Rural health knowledge

Contract oversight

MMIS/eligibility systems

Problem solving

Cross-agency collaboration

Education

Bachelor’s Degree

Tools

Microsoft Excel

Tableau

Job description

State of New Hampshire Job Posting

Office of the Governor

GO-NORTH Division

107 North Main Street

Concord, NH 03301

MEDICARE-MEDICAID INTEGRATION PROGRAM LEAD

Nonclassified Position # NONCEX4048

Annual Salary: $115,000

(In-person; statewide travel required)

See total compensation information at the bottom of announcement.

The Governor’s Office of New Opportunities and Rural Transformational Health (GO-NORTH), was established by Executive Order under Governor Kelly Ayotte and charged with leading the execution and implementation of the State’s Rural Health Transformation (RHT) Plan and its five strategic initiatives to transform rural healthcare in New Hampshire.

Initiative 1: Population Health: Increase prevention services and improve chronic disease management, behavioral, and maternal health.
Initiative 2: Access: Ensure sustainable access to care by strengthening rural hospitals, primary care providers, federally qualified health centers, community mental health centers, emergency medical service agencies, and specialty telehealth services.
Initiative 3: Workforce: Build and retain a skilled rural health workforce through education, training, and career pathways development.
Initiative 4: Technology: Modernize care delivery by expanding technology, interoperability, and data security.
Initiative 5: Financial Sustainability: Promote financial sustainability with innovative payment models and value-based care.

SCOPE OF WORK

A growing share of Medicare beneficiaries living in rural New Hampshire are covered by both Medicare and Medicaid. To support greater integration of dually eligible beneficiaries’ Medicare and Medicaid benefit and care coordination, the State committed to implementing a Highly Integrated Dual Special Needs Plan (D-SNP) by January 1, 2029.

The Medicare-Medicaid Integration Program Lead reports to the GO-NORTH Director of Financial Sustainability & Policy and indirectly to the Deputy Medicaid Director to administer Medicare-Medicaid integration initiatives and projects for the Division of Medicaid Services (DMS), with a primary focus on D-SNPs, Medicare Advantage coordination, and aligned Medicare-Medicaid program operations.

The Medicare-Medicaid Integration Program Lead shall ensure that GO-NORTH and DMS meet D-SNP project and program objectives on schedule and in compliance with federal and state requirements. Administers strategic and operational aspects of Medicare-Medicaid coordination to improve integration of benefits, member experience, care coordination, and program accountability for individuals dually eligible for Medicare and Medicaid.

ACCOUNTABILITIES

Directs the development, implementation, and evaluation of Medicare-Medicaid integration initiatives, including D-SNP-related strategies, ensuring GO-NORTH and DMS goals and objectives are met in alignment with federal and state requirements and maximizing program effectiveness for dually eligible individuals.

Develops strategic and operational plans for advancing aligned Medicare-Medicaid enrollment, benefit coordination, and program oversight in New Hampshire. Directs cross-departmental teams, including Medicaid operations, finance, quality, LTSS, behavioral health, information systems, and partners (e.g., Division of Long-Term Services and Supports, Division of Behavioral Health, etc.) in operationalizing integration strategies and resolving policy and implementation issues involving Medicaid, Medicare Advantage, and contracted health plans.

Serves as the GO-NORTH subject matter expert on Medicare, D-SNP, and Medicare-Medicaid integration policy. This may include analyzing relevant regulations and guidance, and educating internal teams on CMS guidance related to D-SNPs, Medicare Advantage, models of care, eligibility, enrollment, and Medicare policy developments that affect state Medicaid operations.

Leads planning, design, and day-to-day Medicare-Medicaid integration program management including project timelines, work plans, deliverables, risk mitigation, and issue resolution. Regularly reports on program progress, operational readiness, outcomes, and compliance status through reports, metrics, presentations, and updates to leadership and stakeholders.

Leads development, implementation, and oversight of State Medicaid Agency Contract (SMAC) contracts, policies, operational protocols, and reporting requirements related to D-SNPs and other Medicare-Medicaid integrated care models. Tracks contractor and plan compliance with state and federal requirements and supports accountability for performance and member outcomes.

Develops and applies detailed knowledge of Medicare and Medicaid eligibility, enrollment, and file-exchange processes to support aligned enrollment transactions in Medicaid Management Information Systems (MMIS) and New HEIGHTS, and other efforts to minimize gaps, churn, and enrollment discrepancies across programs.

Serves as the primary point of contact for Medicare-Medicaid integration initiatives for external stakeholders, including contracted health plans, providers, community-based organizations, member advocates, and federal partners such as CMS. Fosters concise and effective communication to ensure clarity of objectives, compliance, and timely resolution of issues.

Manages D-SNP oversight and compliance, and works closely with D-SNP compliance teams.

Leads efforts across GO-NORTH and DHHS teams and with contracted health plans to identify, develop, and execute education, training, operational guidance and technical assistance for providers, community-based organizations, and other external partners to build capacity to effectively serve dually eligible individuals and meet state and federal program requirements.

Leads efforts to assess, monitor, and improve program outcomes, including enrollment trends, service utilization, quality performance, grievances and appeals, access issues, and member experience. Designs and implements feedback and monitoring mechanisms to identify program strengths, disparities, operational issues, and opportunities for improvement.

Helps DHHS to build and maintain Medicare policy and operational knowledge across the Department by developing training materials, technical guidance, and internal resources that strengthen staff capacity to design, implement, and oversee Medicare-Medicaid integrated care programs.

PREFERRED EXPERIENCE

Exceptional verbal and written communication skills.
Knowledge of and/or experience working with Medicaid, Medicare, Medicare Advantage, D-SNPs, and/or Medicare-Medicaid integration policy.
Knowledge of health care access, quality and other issues impacting individuals who reside in rural communities.
Experience with managed care contract oversight, compliance monitoring, and performance reporting.
Familiarity with Medicaid Management Information Systems (MMIS), eligibility systems, encounter or claims data, and operational interfaces that support Medicare-Medicaid alignment.
Experience researching eligibility, enrollment, payment, and program discrepancies using Medicaid systems, managed care reporting, or related data sources.
Competence in functioning effectively and collaboratively as a member of a work team and in leading cross agency workgroups.
Exemplary at working independently and meeting deadlines for short term priorities.
Strong, solution-oriented approach to problem-solving, facilitation, organization, and project execution.
Proficiency in the use of computers and software to generate statistical analyses and project/progress reports, preferably with Microsoft Excel and/or Tableau.

QUALIFICATIONS

Education: Bachelor’s Degree
Experience: At least three (3) years of relevant experience, including Medicaid or Medicare policy, managed care, overseeing health care programs

For further information please contact David Chorney, Director of Financial Sustainability at David.A.Chorney@go-north.nh.gov.

TOTAL COMPENSATION INFORMATION

The State of NH total compensation package features an outstanding set of employee benefits, including: