Product Director

Overview

Oversees the strategic planning and administration for VNS Health Mainstream Medicaid Plan along with launch of IB Dual Status, focusing on product growth and performance against defined goals and criteria. Collaborates with Health Plan leadership in the development of a business plan that is aligned with the strategic goals and objectives of the organization. Ensures compliance with all applicable contracts and government regulations.

Leads the end-to-end development, implementation, and operational oversight of our Mainstream Medicaid product in New York State. Possesses a deep understanding of Medicaid regulations, experience with government-sponsored health programs, and the ability to manage complex, cross-functional initiatives. Translates state and federal policy into actionable business plans, ensure operational readiness, and drive alignment across clinical, operational, and compliance teams. Ensures successful product performance, regulatory adherence, and long-term growth in New York's Medicaid Managed Care market.

This role is critical to ensuring successful product performance, regulatory adherence, and long-term growth in New York's Medicaid Managed Care market.

What We Provide:

• Referral bonus opportunities     
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays   
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability    
• Employer-matched retirement saving funds   
• Personal and financial wellness programs    
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care   
• Generous tuition reimbursement for qualifying degrees   
• Opportunities for professional growth and career advancement    
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities   

What You Will do

• Translates Medicaid and Medicare regulatory requirements into scalable operational processes.
• Leads cross-functional steering committees to ensure enterprise-wide understanding and alignment with policy changes.
• Drives continuous improvement initiatives that enhance member experience, compliance, and operational efficiency.
• Directs Medicaid service-area expansion strategy, application development, and state submission processes.
• Coordinates with internal departments (legal, provider network, finance) to ensure all expansion requirements are met.
• Serves as point of contact with New York State Department of Health (DOH) regarding expansion approvals and follow-ups alongside Government Affairs.
• Leads the development and launch of IB-Duals products, managing state applications, governance structures, and implementation timelines.
• Oversees the build-out of member materials, ID card integration, portal experience, and state-specific reporting tools.
• Ensures all requirements from both Medicare and Medicaid regulators are met across systems and operations.
• Partners with Compliance to create a decentralized triage and accountability structure for Mainstream Medicaid regulatory issues.
• Monitors regulatory updates and model contract changes, ensuring proactive operational response and documentation.
• Supports internal audits, readiness assessments, and corrective action plans.
• Supports and guides project managers and initiative owners across departments to deliver Medicaid-related initiatives on time and within scope.
• Balances stakeholder needs, timelines, and compliance risks, while maintaining visibility to senior leadership.
• Leads initiative tracking and reporting to ensure key milestones and metrics are achieved.
• Owns preparation for DOH operational readiness reviews, including coordination of documentation, operational walkthroughs, and follow-up deliverables.
• Identifies and resolves gaps in compliance or implementation prior to state evaluations.
• Serves as primary liaison for state auditors during Medicaid audits and reviews.
• Collaborates with Medical Management, Behavioral Health, and SDoH teams to align workflows with the model of care.
• Ensures operational support for care management, member engagement, and clinical programs.
• Participates in care model innovation, benefit design, and member experience improvement initiatives.
• Collaborates with the Implementations team tasked with managing systems and data configurations related to eligibility, benefits, claims processing, and provider data accuracy.
• Oversees submission of state-required reports, such as MMCOR, PND, and encounter data files.
• Ensures integrity of provider directories, network reports, and regulatory submissions.

Qualifications

Education:
Bachelor's Degree in Business Administration, Healthcare Administration, Marketing or related field of study required
Master's Degree in related field (MPH, MBA, MPA, or equivalent) preferred

Work Experience:
Minimum 7 years of experience in a health insurance organization with a focus on one or more of the following product lines: Medicaid managed care, Managed Long Term Care, Commercial or Special Needs Plans and a minimum of one year of experience in product management required
Progressive experience in health care administration, planning and financial oversight required
Knowledge of Health Plan product assessment and development required
Project management and Medicaid managed care experience required
Ability to manage P&L for Medicare/Medicaid Plans required
Demonstrated ability to collaborate and interact cooperatively with all levels of management and their staff required
Experience with health plan operations, compliance, and audits required
Familiarity with Medicaid Managed Care Model Contract in NYS required
Proficiency in managing data/reporting requirements and system implementation required
In-depth knowledge of New York State Medicaid programs and policy, including Mainstream Medicaid, HARP, MLTC, and/or IB-Duals required
Experience working with regulatory bodies (e.g., NYS DOH, CMS) required
Experience working with benefit design, provider networks, medical management, marketing strategies and tactics, and claims required
Effective communication skills, both written and oral, and strong common PC software applications (i.e. Microsoft Office) skills required

Pay Range

USD $137, USD $183,800.00 /Yr.
About Us

VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

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