Director, Government Programs Clinical Operations (Medicaid)

Location: Hybrid role based in Downers Grove, Illinois, with at least three days per week in the office; travel, including overnight stays, is required.

Base pay: $121,200–$225,200 annually, plus eligibility for an annual incentive bonus.

Company

hirify.global provides health insurance and government program services with a focus on member care, compliance, and operational performance.

What you will do

• Direct process changes and project integration for Medicare Advantage, Medicaid, and dual-eligible clinical operations.
• Optimize clinical review processes across Operations, Marketing/Sales, and Medical departments.
• Maintain compliance with accreditation standards and government regulations.
• Develop cost-of-care initiatives and clinical management tools supporting quality, expense, and performance goals.
• Oversee high-dollar claims triage and reporting, quality analysis, performance metrics, customer service standards, and performance guarantees.
• Manage staff, budgets, resource allocation, business cases, cost-benefit analyses, professional development, and performance improvement plans.

Requirements

• Bachelor’s degree or current, unrestricted clinical licensure such as RN, LISW, LMSW, LPC, LCPC, or LCSW.
• At least 4 years of management experience and 8 years of experience in managed care operations, care management, clinical quality, or government-sponsored health programs.
• Knowledge of Medicaid claims payment rules, state and federal regulations, managed care principles, accreditation standards, and quality improvement.
• Experience developing business requirements and reporting, managing projects, planning and implementing medical processes, and analyzing performance.
• Collaborative leadership, team-building, analytical, communication, presentation, and Microsoft Office skills.
• Ability and willingness to work in the Downers Grove office at least three days per week and travel as required.

Nice to have

• Master’s degree in Nursing or another Health Sciences field.
• Certification in case management, healthcare administration, or project management.
• Clinical leadership experience with pediatric special-ne needs, chronically ill, disabled, low-income, or frail populations.
• Experience with Texas Medicaid, MDCP, Texas State Special Needs Waivers, or new program implementations.
• Bilingual English/Spanish communication skills.

Culture & Benefits

• Curated development plans and professional development opportunities.
• Health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, and supplemental life insurance.
• Employee assistance program, paid holidays, tuition reimbursement, and additional incentives.
• Equal-opportunity workplace with confidentiality, compliance, diversity, and corporate integrity expectations.