California Licensed Eligibility Director

A company is looking for a Senior Director, Eligibility Excellence.

Key Responsibilities

Lead the design and execution of a scalable Eligibility Center of Excellence, overseeing policies and operational workflows

Direct daily eligibility operations, ensuring compliance, accuracy, and timely processing of redeterminations and participant communications

Establish and manage KPIs and audit routines to monitor performance and regulatory risk across eligibility operations

Required Qualifications

Bachelor's degree required; master's degree in a related field preferred

Minimum of ten (10) years of experience in Medicaid and Medicare eligibility and enrollment operations

Proven experience in regulated healthcare environments with responsibility for eligibility strategy and policy execution

Minimum of five (5) years of leadership experience managing large eligibility teams or platforms

Strong knowledge of federal and state Medicaid policy and related processes