Our Team, Your Impact

As Director / Senior Director of Medicaid Revenue Optimization & Automation, you will lead the transformation of Medicaid rebate operations by leveraging advanced technology, process automation, and data-driven strategies. Your mission is to drive operational excellence, eliminate revenue leakage, and ensure seamless dispute resolution, with a strategic focus on optimizing both generic and branded pharmaceutical portfolio operations. You will ensure that all assigned State Medicaid rebate programs fully comply with CMS and other regulatory requirements, and that all program activities are actively monitored, well-staffed, and effectively communicated across the organization.

How You'll Spend Your Day
• Regulatory Compliance & Program Oversight:
Ensure each assigned State's Medicaid rebate program adheres to all CMS and applicable federal/state requirements. Actively monitor federal and supplemental rebate programs, maintain appropriate staffing levels, and oversee comprehensive training for Medicaid analysts.
• Technology-Driven Process Leadership:
Champion the adoption of cutting-edge automation tools (AI, Bots) to streamline Medicaid rebate processing, data validation, and reporting. Continuously assess and implement digital solutions to enhance accuracy, speed, and scalability, including the use of Model N's Flex system for Medicaid adjudications.
• Project Management & Innovation:
Lead cross-functional projects to re-engineer Medicaid processing workflows, integrating best practices in project management to deliver measurable improvements in cycle time, compliance, and cost efficiency. Foster a culture of innovation and continuous improvement by identifying emerging opportunities and piloting new approaches to enhance operational performance.
• Revenue Integrity & Leakage Prevention:
Design and implement robust controls and analytics to proactively identify and prevent revenue leakage across all Medicaid transactions. Develop dashboards and exception reporting to monitor trends, root causes, and corrective actions.
• Strategic Dispute Resolution:
Oversee the end-to-end dispute management process, utilizing advanced analytics and automation to resolve claim discrepancies efficiently. Collaborate with state agencies and internal teams to ensure timely, data-backed resolutions and minimize outstanding balances.
• Effective Medicaid Operations:
Support the adjudication, validation, and dispute resolution of Medicaid rebates for both generic and branded pharmaceutical products, with increased attention to the complexities and compliance requirements of branded products. Ensure all claim processing and dispute activities are executed with precision, in alignment with regulatory standards and internal controls, while collaborating with relevant teams to address product-specific issues as they arise.
• Stakeholder Alignment & Engagement:
Maintain close alignment with internal and external stakeholders, including state agencies, finance, value & access, IT, and compliance, to ensure seamless Medicaid operations. Stay continuously informed on all relevant government legislation, program guidance, and any new contracts or amendments, promptly updating processes and communicating changes. Facilitate clear, timely communication and collaborative problem-solving to support compliance and operational excellence.
• Training, People Development & Collaborative Culture:
Lead comprehensive training and development programs to ensure team members possess the latest knowledge and skills in Medicaid rebate adjudication, claim validation, and dispute resolution. Champion a culture of continuous learning, open communication, and mutual respect, encouraging team members to share ideas, raise concerns, and collaborate freely. Promote professional growth and cross-training, empowering staff to adapt to evolving processes and technologies while supporting each other's success.
• Team Leadership & Management:
Manage and mentor a large team of 10+ professionals, fostering a high-performance culture focused on accountability, collaboration, and results. Provide strategic direction, performance feedback, and career development opportunities to ensure team engagement and retention.
• Budget & Financial Forecasting:
Drive continuous improvement initiatives and maintain accountability for all Medicaid rebate budget and financial forecasting activities.

Your Skills and Experience

Bachelor's or Master's degree (preferred) in Business, Finance, Data Science, Information Systems, or related field.
• 10+ years of biopharmaceutical pricing and contracting experience with 7+ years of Medicaid rebate or pharmaceutical revenue management experience, with proven leadership in process automation and technology adoption.
• Demonstrated expertise in project management, including leading cross-functional initiatives and driving change management to implement new technologies and optimize processes.
• Strong background in process automation (AI, Bots) and process optimization, with a track record of delivering measurable improvements in efficiency, accuracy, and compliance.
• Proven track record of innovation in developing and implementing forward-thinking solutions that enhance operational performance and drive strategic value.
• Advanced proficiency with Medicaid adjudication platforms (Model N, Flex, or similar), and data analytics tools.
• Excellent analytical, problem-solving, and communication skills, with the ability to manage multiple priorities and adapt to evolving regulatory and business environments.
• Experience in both generic and branded pharmaceutical segments preferred.

Salary Range

The annual starting salary for this position is between $221,850-258,825 annually. Factors which may affect starting salary within this range and level of role may include geography/market, skills, education, experience and other qualifications of the successful candidate.

How We'll Take Care of You

We offer a competitive benefits package, including:
• Comprehensive Health Insurance: Medical, Dental, Vision, and Prescription coverage starting on the first day of employment, providing the employee enrolls.
• Retirement Savings: 401(k) with employer match, up to 6% and an annual 3.75% Defined Contribution to the 401k plan.
• Time Off: Paid Time Off including vacation, sick/safe time, caretaker time and holidays.
• Life and Disability Protection: Company paid Life and Disability insurance.
• Additional benefits include, but are not limited to, Employee Assistance Program, Employee Stock Purchase Plan, Tuition Assistance, Flexible Spending Accounts, Health Savings Account, Life Style Spending Account, Volunteer Time Off, Paid Parental Leave, if eligible , Family Building Benefits, Virtual Physical Therapy, Accident, Critical Illness and Hospital Indemnity Insurances, Identity Theft Protection, Legal Plan, Voluntary Life Insurance and Long Term Disability and more.

The total compensation may also include restricted stock units and discretionary awards, depending on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

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