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Manager, Medicaid Eligibility and Program Policy

Primary Location: New York, NY
Additional Locations: NY-New York
The National DSNP Program Office supports Dual Special Needs Plans (DSNP) growth, expansion, strategy, clinical and administrative operations for all DSNPs offered by Aetna. The primary goal of the Manager, Medicaid Eligibility and Program Policy is to ensure that all areas supporting DSNP products have the information needed to effectively meet member needs and their operational requirements. The Manager, Medicaid Eligibility and Program Policy, will be responsible for documenting and developing a detailed understanding of Medicaid eligibility and policy for dual eligibles including Medicaid programs and delivery systems in all states in which we operate or plan to operate a DSNP. They will work with internal stakeholders to develop resource, education and training materials with state-specific details regarding eligibility for various Medicaid programs, how individuals apply for Medicaid and specific managed care or waivered services, how services are provided, covered benefits and services, payment policy, etc. Stakeholders will include but are not limited to DSNP care management, customer service, claims, marketing and sales, product, operations integrity, market-based resources, etc.

Fundamental Components:
To be successful in this position the candidate must have demonstrated experience and knowledge of Medicaid eligibility and state policy for multiple states, demonstrated experience in researching and gaining a detailed understanding of state Medicaid programs specifically those serving dual eligibles, demonstrated experience in working with training and education areas, project management skills, demonstrated ability to work in a matrix and cross functional environment. The candidate must maintain advanced understanding of Medicaid eligibility and policy as well as Aetna’s DSNP /business strategy, customers, healthcare, and regulatory environment, as well as product vision/strategy, product components, and Aetna systems.

The Manager, Medicaid Eligibility and Program Policy will be responsible for documenting, through regulatory and other research detailed information regarding Medicaid eligibility and Medicaid programs and services for dual eligible. This will include but is not limited to eligibility for various Medicaid programs, how individuals apply for Medicaid, specific managed care programs, waivered services and programs, how services are provided, Medicaid payment policy, covered benefits and services, etc. They will work with internal stakeholders and functional areas including the Medicare Services Organization, Medicare Marketing and Sales, DSNP Care Management, Medicare Product, Member Experience, Member Retention, Stars, and others to identify information needs regarding Medicaid eligibility and programs for dual eligible in states that we offer or plan to offer a DSNP. Working with training and development within these areas and corporately, they will provide subject matter expertise and content for all relevant training materials. This may include training materials and desk top tools for customer service staff so that they are able to assist members understand state specific Medicaid services, working with DSNP Care Management to develop protocols for Medicaid recertification and implementation of requirements related to coordination of Medicaid benefits and services, etc. They will work as part of project teams to implement new DSNP requirements that require detailed knowledge of Medicaid overall and at individual state levels.

Elevate risks, communicate dependencies, and recommend alternative solutions in timely manner that allows for mitigation and/or strategic reaction. Work effectively across business areas by building and leveraging strong relationships. Identify and mobilize cross-functional support required to achieve business objectives, including areas of tactical and strategic support. Develop and manage detailed project plans to track product development and commercialization. Effectively manage multiple competing products/projects with effective prioritization and eye for detail. Take full accountability for end result, serve as product expert, and leverage all resources available to achieve objectives. Select and build strong teams through formal training, diverse assignments, coaching, mentoring and other developmenttechniques.

Background Experience:
1+ years of Experience with and knowledge of Medicaid programs, services, and eligibility at the state levels including dual eligibles; Required
Federal Medicaid experience and Knowledge; Preferred

Experience with Dual Special Needs Plans; Preferred
Process of Policy Development Experience; Preferred

5+ years related cross-functional, program management experience; Required
Bachelor's Degree or equivalent; Required
Advanced Degree; Preferred

Additional Job Information:
Opportunity to be part of fastest growing part of company and newly formed national leadership group, bringing subject matter expertise and knowledge to a diverse group of stakeholders.

Required Skills:
General Business - Consulting for Solutions, General Business - Demonstrating Business and Industry Acumen, Service - Providing Solutions to Constituent Needs

Desired Skills:
Leadership - Driving Strategic and Organizational Agility, Sales - Delivering on the Promise, Service - Managing Organizational Dynamics

Functional Skills:
Lega - Compliance - training/education, Lega - Product and regulatory filings, Management - Management - Product development

Technology Experience:
Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)


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