Manager, Medicaid Policy and Payment Model Implementation - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

OptumServe Consulting/The Lewin Group (OSC/Lewin), a premier national health care and human services consulting and policy analysis firm, brings 50 years of experience finding answers and solving problems for leading organizations in the public, non-profit, and private sectors. Lewin's strategic and analytical services aim to help clients:

In the wide-ranging field of health human services consulting, OSC/Lewin provides both depth and breadth of expertise. Currently, OSC/Lewin has more than 250 consultants drawn from industry, government and academia. They all share a solid commitment to OSC/Lewin's core values of objectivity, integrity, analytical innovation, vision, and dedication to client satisfaction.

At OSC/Lewin, we help federal decision-makers strengthen health and human services programs, make informed policy choices, and implement critical initiatives. OSC/Lewin also works with foundations and associations to research and evaluate complex health care and human services needs. By delivering objective, data-driven research, program planning and development, technical assistance, implementation, post-implementation analytics, and evaluations, OSC/Lewin supports current program activities, informs future program investments and supports strategic decision processes that improve the health and well-being of the nation's citizens.

The Senior Consultant will serve as the Lewin-side Medicaid lead/counterpart to CMMI staff for various models, moving Medicaid policy, technical assistance, and operational work forward across task teams. This person should be an experienced individual contributor who can independently structure ambiguous work, advise CMS, coordinate SMEs, and deliver high-quality work.

You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities

Serve as a senior Medicaid policy and implementation advisor supporting various models including the Transforming Maternal Health Model (TMaH), working closely with CMS Innovation Center staff and Lewin task leads to advance Medicaid-related priorities

Lead and coordinate Medicaid work across TMaH task teams, establishing work plans, clarifying responsibilities, identifying dependencies, and driving activities through completion

Provide policy consultation, structured analysis, and thought partnership to CMS on Medicaid payment and delivery-system reforms, including alternative payment models, value-based care, hospital global budgets, advanced primary care, and multi-payer alignment (with a maternal health focus)

Analyze federal and state Medicaid policies, authorities, programs, and implementation approaches, including state plan and waiver considerations, and translate findings into clear options, recommendations, and decision materials

Translate model policy and methodology into clear data specifications, business rules, and code for core payment model functions, including beneficiary attribution, payment calculations, and quality measurement

Lead continued development on data-based simulation modeling to support TMaH model decision making for model cost-effectiveness and cost-neutrality

Understand Medicaid data, quality measurement, or program monitoring sufficiently to interpret analytic findings and incorporate them into policy recommendations

Experience and understanding with CMCS Core Set, CCSQ Quality Strategy, Digital quality measurement strategy and/or electronic clinical quality measure decision support tools

Support the development and refinement of Medicaid policies and operational approaches that account for differences in state delivery systems, including Medicaid fee-for-service and managed care environments

Design and lead technical assistance strategies that help states and other stakeholders implement Medicaid payment and delivery-system reforms and improve health and human service delivery programs

Develop and review high-quality technical assistance products, including policy memos, issue briefs, implementation roadmaps, guidance documents, presentations, webinars, frequently asked questions, and other stakeholder-facing materials

Facilitate discussions with CMS, state partners, subject-matter experts, contractors, and internal teams to resolve open policy and operational questions and build alignment around recommended approaches

Translate complex Medicaid policy and payment issues for technical and non-technical audiences, clearly distinguishing policy decisions, operational implications, risks, dependencies, and unresolved questions

Summarize analytic findings and methodology for technical and non-technical audiences, including memos, tables, and presentation materials for CMS

Identify implementation risks, policy gaps, and emerging issues; develop options and recommendations; and elevate decisions requiring CMS direction

Review deliverables for accuracy, consistency, policy alignment, and practical usability, maintaining a high degree of quality and attention to detail

Support and mentor colleagues across task teams by providing Medicaid subject-matter guidance, structured problem-solving support, and review of work products

Contribute to broader project planning, client relationship development, and proposal or business-development activities, as needed

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

6+ years of relevant professional experience in Medicaid policy, health policy consulting, government programs, technical assistance, program implementation, healthcare delivery transformation, or a related field, with at least 2+ years of direct experience working with T-MSIS data

Demonstrated experience analyzing Medicaid policy, program design, payment policy, delivery systems, or operational implementation

Experience supporting the design, implementation, evaluation, or operation of alternative payment models, value-based care programs, or other healthcare payment and delivery-system reforms

Demonstrated ability to independently lead complex workstreams, organize ambiguous assignments, manage competing priorities, and drive work to completion

Experience leading cross-functional teams or coordinating work across multiple teams and subject-matter experts without direct reporting authority

Demonstrated ability to provide policy consultation and develop clear, well-supported options and recommendations for senior clients or decision-makers

Preferred Qualifications

Experience supporting a CMS Innovation Center model or another federal healthcare demonstration

Experience working in or directly supporting a state Medicaid agency, CMS, CMCS, CMMI, a Medicaid managed care organization, or a Medicaid policy or technical-assistance contractor

Knowledge of Medicaid managed care and fee-for-service delivery systems

Understanding of maternal health and global billing practices in State Medicaid contexts

Familiarity with Medicaid authorities and implementation mechanisms, such as state plan amendments, Section 1115 demonstrations, managed care authorities, or state-directed payment arrangements

Experience advising federal or state clients on policy design, implementation options, operational feasibility, and stakeholder implications

Experience designing or delivering technical assistance to states, health plans, providers, hospitals, primary care practices, or other healthcare stakeholders

Experience developing practical implementation tools, such as readiness assessments, roadmaps, decision frameworks, issue trackers, or operational guidance

Experience collaborating with policy makers, state health officials, actuaries, clinicians, data analysts, payment-methodology experts, and operations teams

Familiarity with CMCS Core Set, CCSQ Quality Strategy, Digital quality measurement strategy and/or electronic clinical quality measure decision support tools

Ability to efficiently manage competing priorities and balance the needs of multiple stakeholders

Consulting experience managing multiple concurrent assignments and responding to evolving federal client priorities

Solid written communication skills, including experience drafting policy memoranda, issue briefs, implementation guidance, presentations, or similar client-facing materials

Solid verbal communication and facilitation skills, with the ability to translate complex policy and operational issues for technical and non-technical audiences

Demonstrated attention to detail and ability to produce accurate, high-quality work in a fast-moving client-service environment

Ability to work effectively both independently and collaboratively in a multidisciplinary project environment

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.