Manager, Medicaid Regulatory Adherence

The Manager of Medicaid Regulatory Adherence serves as the primary regulatory point of contact for Medicaid/Special Needs programs in North Dakota (ND), Minnesota (MN), and Wisconsin (WI). This position leads a team of Regulatory Adherence Analysts and is responsible for managing relationships with state Medicaid agencies; interpreting and implementing regulatory changes; and ensuring contract and regulatory adherence across the organization. The role also partners closely with Medica's enterprise compliance team to ensure alignment with corporate standards and frameworks. Performs other duties as assigned.

Key Accountabilities:

Regulatory and State Engagement

• Serve as the primary Medicaid regulatory liaison with state agencies in ND, MN, and WI.
• Develop and lead annual contract assessment reviews of existing and new contract requirements.
• Lead state Medicaid contract negotiations, renewal, and amendment process.
• Monitor trends of State Medicaid agency inquiries and issues, communicate internally, implement corrective action as needed.
• Monitor and analyze Medicaid and Special Needs Plan regulatory changes, guidance, and legislation, and translate those changes into actionable requirements for internal teams.
• Identify and communicate any known regulatory risks to Medicaid leadership team.

Team Leadership and Oversight

• Manage and develop team of four Regulatory Adherence Analysts, providing direction, coaching, and performance management.
• Assign work and ensure timely and accurate completion of deliverables related to compliance monitoring, regulatory analysis, and reporting.
• Foster a culture of accountability, transparency, and continuous improvement within the team.

Compliance Collaboration

• Serve as the primary Medicaid liaison to Medica's corporate compliance team to support audits, corrective action plans, training, and policy development.
• Ensure internal policies and procedures reflect current Medicaid requirements and contractual obligations.
• Coordinate with cross-functional teams (e.g., Legal, Operations, Quality, and Network) to drive compliant execution of Medicaid programs.

External Partnerships

• Participate in external workgroups and partnerships
• Represent Medica on committees and workgroups as necessary

Required Qualifications:

• Bachelor's degree or equivalent experience in related field
• 5 years of work experience beyond degree in Medicaid regulatory adherence or Medicaid product role

Strongly Preferred Qualifications:

• At least 5 years of experience in a people management or team leadership role.
• Strong understanding of Medicaid regulations and state contracts.
• Proven experience interpreting regulatory requirements and applying them in managed care settings.
• Excellent communication, negotiation, and interpersonal skills, with the ability to build relationships with internal and external stakeholders.
• Experience working directly with state Medicaid agencies in ND, MN, or WI.
• Familiarity with regulatory tracking tools.
• Experience with managed care organization (MCO) contract negotiations.
• Ability to communicate effectively both verbally and in writing
• Strong ability to identify risks, communicate to leadership and work collaboratively to develop solution to close gap.
• High level of detail orientation

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary range for this position is $87,100 - $149,300. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.