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.

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 [email protected].

*TOTAL COMPENSATION INFORMATION

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

HMO or POS Medical and Prescription Drug Benefits:

The actual value of State-paid health benefits and the amount of employee health benefit contributions may vary depending on the type of plan selected and the bargaining unit with which a position is associated.

See this link for details on State-paid health benefits:

https://www.das.nh.gov/hr/benefits.aspx

Value of State's share of Employee's Retirement: 12.87% of pay

Other Benefits:

*Dental Plan at minimal cost for employees and their families ($500-$1800 value)

* Flexible Spending healthcare and childcare reimbursement accounts

*State defined benefit retirement plan and Deferred Compensation 457(b) plan

*Work/life balance flexible schedules, paid holidays and generous leave plan

*$50,000 state-paid life insurance plus additional low-cost group life insurance

*Incentive-based Wellness Program (ability to earn up to $500)

Total Compensation Statement Worksheet:

https://www.das.nh.gov/jobsearch/compensation-calculator.aspx

Want the specifics? Explore the Benefits of State Employment on our website:

https://www.das.nh.gov/hr/documents/BenefitBrochure.pdf

https://www.das.nh.gov/hr/index.aspx