California Licensed Eligibility Director

Job Summary

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