CrawlJobs Logo

Senior Manager, Government Programs - Medicaid

https://www.baxter.com/ Logo

Baxter

Location Icon

Location:
United States , Saint Paul, Minnesota

Category Icon

Job Type Icon

Contract Type:
Employment contract

Salary Icon

Salary:

152000.00 - 209000.00 USD / Year

Job Description:

The Senior Manager for Government Programs - Medicaid at Baxter will work to ensure patient access and sustainable pricing for medical devices, particularly Respiratory Health products. Responsibilities include developing relationships with Medicaid administrators, resolving reimbursement issues, analyzing trends, and collaborating with internal teams. The role offers flexible workplace policies and a comprehensive benefits package.

Job Responsibility:

  • Develop relationships with Medicaid Administrators to assist in clarification of state policies and find opportunities for coverage development
  • Act as the primary contact for Respiratory Health to Government Programs in communications and meetings
  • Supervise Government Payer requirements & policies to identify potential changes that may impact Respiratory Health’s reimbursement process
  • Lead resolution of Medicaid payer issues brought up from Patient & Customer Service teams
  • Advance questions requiring Legal or Compliance guidance related to reimbursement processes to appropriate resource
  • Participate in industry Trade Associations or State HME / DME Associations
  • Collaborate with Government Affairs on state lobbying efforts
  • Analyze government program trends applying internal and external data
  • Maintain communication with senior management regarding major reimbursement issues
  • Assist the Coverage Manager on Coverage Expansion strategy development
  • Assist the Managed Care Directors on acquiring new contracts with Medicaid Managed Care programs and lead projects for Medicaid transitions to Managed Care.

Requirements:

  • Bachelor’s degree required
  • 6 plus years in health policy, reimbursement, Medicaid and public health payment programs is required
  • 3 plus years of pharmaceutical/medical device proven experience is required
  • Proven understanding of Medicaid systems and differences in state operations required
  • Detailed understanding of state programs, processes, and experience preferred
  • Established track record of cultivating relationships with Medicaid Administrators, specifically directors, policy managers, and medical directors, through articulate written and verbal communication.

Nice to have:

  • Graduate degree a plus
  • Experience with state programs and processes preferred.
What we offer:
  • Medical and dental coverage that start on day one
  • Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
  • Employee Stock Purchase Plan
  • 401(k) Retirement Savings Plan
  • Flexible Spending Accounts
  • Educational assistance programs
  • Paid holidays
  • Paid time off ranging from 20 to 35 days based on length of service
  • Family and medical leaves of absence
  • Paid parental leave
  • Commuting benefits
  • Employee Discount Program
  • Employee Assistance Program
  • Childcare benefits.

Additional Information:

Job Posted:
March 21, 2025

Employment Type:
Fulltime
Work Type:
Hybrid work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Senior Manager, Government Programs - Medicaid

Director Utilization Management

The Director of Utilization Management is a strategic clinical operations leader...
Location
Location
United States , New York
Salary
Salary:
154600.00 - 236555.00 USD / Year
healthfirst.org Logo
Healthfirst
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s degree in healthcare, business, or a related field from an accredited institution or equivalent work experience
  • Progressive leadership experience in healthcare management including work experience in a mid-senior management role
  • Work experience and deep familiarity of health plans such as Medicare, Medicaid and/or Managed Long-Term Care Plan (MLTCP)
  • Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations
  • Work experience interpreting and operationalizing regulatory updates and guidance from DOH and CMS
  • Work experience demonstrating written and verbal communication skills with the ability to influence and collaborate across all levels and functions
  • Demonstrated success driving high performance and quality outcomes in a fast-paced, regulated environment
Job Responsibility
Job Responsibility
  • Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests
  • Develop strong operational and leadership capabilities within the organization through performance improvement, career development, and coaching
  • Develop and implement policies and procedures that align with industry standards, payer guidelines, and regulatory requirements
  • Deliver on Healthfirst’s Mission by ensuring optimum quality of member care in a cost-effective manner
  • Ensure UM operations meet regulatory requirements set forth by CMS, New York State Department of Health (DOH), and other oversight entities
  • Develop and monitor appropriate metrics to maintain and improve department performance
  • Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement
  • Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program, sometimes through the implementation of new technology
  • Serve as the operational subject matter expert on business development efforts related to UM programs, including the launch of new products or regulatory initiatives
  • Collaborate closely with other Operations leaders including but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions
What we offer
What we offer
  • medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions
  • Fulltime
Read More
Arrow Right

Senior Manager, Government Pricing

This is a high‑impact leadership role at the center of Baxter’s most complex and...
Location
Location
United States , Deerfield
Salary
Salary:
136000.00 - 187000.00 USD / Year
https://www.baxter.com/ Logo
Baxter
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 8–10 years of experience in Government Price Reporting preferred (open to strong candidates with 6+ years and demonstrated mastery)
  • Deep expertise in U.S. government pricing programs, including Medicaid (AMP/BP), Medicare Part B (ASP), 340B, Non‑FAMP, VA/FSS, and state transparency reporting
  • Proven ability to interpret complex regulations, guide policy decisions, and translate methodology into business risk and opportunity
  • Experience partnering with senior leaders across Commercial, Finance, Legal, IT, and Marketing to influence strategy and drive alignment
  • Strong analytical and modeling skills, including scenario analysis related to price changes, legislative developments, and IRA exposure
  • Demonstrated success building sustainable controls, audit frameworks, and scalable processes in highly regulated environments
  • Leadership experience managing teams, developing talent, and overseeing vendors or managed service providers
  • Systems acumen, ideally with Model N or similar pricing/contracting platforms, and comfort navigating complex data environments
Job Responsibility
Job Responsibility
  • Serve as Baxter’s enterprise subject matter expert on government pricing regulations, methodology, and policy interpretation
  • Lead end‑to‑end ownership of AMP, BP, ASP, 340B, and Non‑FAMP submissions, ensuring accuracy, compliance, and timely delivery
  • Advise Commercial, Finance, Legal, Marketing, and Market Access on downstream impacts of pricing strategies, contract structures, and legislative developments
  • Oversee outsourced calculation partners, data inputs, and system outputs, including governance of Model N and other managed service providers
  • Partner closely with Finance and Revenue Accounting to manage reserves, monitor long‑standing accruals, and ensure alignment on financial exposure
  • Lead reconciliation, validation, and audit‑readiness frameworks across all government pricing programs and state transparency requirements
  • Provide support and coordination for the Medicaid rebate process, manage vendor performance, and cash recovery efforts while maintaining strong relationships with CMS, HRSA, VA, DoD, and state agencies
  • Drive process standardization, unbundling initiatives, system modernization, and special projects that shape the future of Baxter’s government pricing function
What we offer
What we offer
  • Support for Parents
  • Continuing Education/ Professional Development
  • Employee Heath & Well-Being Benefits
  • Paid Time Off
  • 2 Days a Year to Volunteer
  • medical and dental coverage that start on day one
  • insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
  • Employee Stock Purchase Plan (ESPP)
  • 401(k) Retirement Savings Plan (RSP)
  • Flexible Spending Accounts
  • Fulltime
Read More
Arrow Right

Senior Manager, Government Pricing

This is a high‑impact leadership role at the center of Baxter’s most complex and...
Location
Location
United States , Deerfield
Salary
Salary:
136000.00 - 187000.00 USD / Year
https://www.baxter.com/ Logo
Baxter
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 8–10 years of experience in Government Price Reporting preferred (open to strong candidates with 6+ years and demonstrated mastery)
  • Deep expertise in U.S. government pricing programs, including Medicaid (AMP/BP), Medicare Part B (ASP), 340B, Non‑FAMP, VA/FSS, and state transparency reporting
  • Proven ability to interpret complex regulations, guide policy decisions, and translate methodology into business risk and opportunity
  • Experience partnering with senior leaders across Commercial, Finance, Legal, IT, and Marketing to influence strategy and drive alignment
  • Strong analytical and modeling skills, including scenario analysis related to price changes, legislative developments, and IRA exposure
  • Demonstrated success building sustainable controls, audit frameworks, and scalable processes in highly regulated environments
  • Leadership experience managing teams, developing talent, and overseeing vendors or managed service providers
  • Systems acumen, ideally with Model N or similar pricing/contracting platforms, and comfort navigating complex data environments
Job Responsibility
Job Responsibility
  • Serve as Baxter’s enterprise subject matter expert on government pricing regulations, methodology, and policy interpretation
  • Lead end‑to‑end ownership of AMP, BP, ASP, 340B, and Non‑FAMP submissions, ensuring accuracy, compliance, and timely delivery
  • Advise Commercial, Finance, Legal, Marketing, and Market Access on downstream impacts of pricing strategies, contract structures, and legislative developments
  • Oversee outsourced calculation partners, data inputs, and system outputs, including governance of Model N and other managed service providers
  • Partner closely with Finance and Revenue Accounting to manage reserves, monitor long‑standing accruals, and ensure alignment on financial exposure
  • Lead reconciliation, validation, and audit‑readiness frameworks across all government pricing programs and state transparency requirements
  • Provide support and coordination for the Medicaid rebate process, manage vendor performance, and cash recovery efforts while maintaining strong relationships with CMS, HRSA, VA, DoD, and state agencies
  • Drive process standardization, unbundling initiatives, system modernization, and special projects that shape the future of Baxter’s government pricing function
What we offer
What we offer
  • Support for Parents
  • Continuing Education/ Professional Development
  • Employee Heath & Well-Being Benefits
  • Paid Time Off
  • 2 Days a Year to Volunteer
  • medical and dental coverage that start on day one
  • insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
  • Employee Stock Purchase Plan (ESPP)
  • 401(k) Retirement Savings Plan (RSP)
  • Flexible Spending Accounts
  • Fulltime
Read More
Arrow Right

Senior Manager, Government Pricing

This is where your insights influence change. As a member of the Baxter Finance ...
Location
Location
United States , Deerfield
Salary
Salary:
136000.00 - 187000.00 USD / Year
https://www.baxter.com/ Logo
Baxter
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 8–10 years of experience in Government Price Reporting preferred (open to strong candidates with 6+ years and demonstrated mastery)
  • Deep expertise in U.S. government pricing programs, including Medicaid (AMP/BP), Medicare Part B (ASP), 340B, Non‑FAMP, VA/FSS, and state transparency reporting
  • Proven ability to interpret complex regulations, guide policy decisions, and translate methodology into business risk and opportunity
  • Experience partnering with senior leaders across Commercial, Finance, Legal, IT, and Marketing to influence strategy and drive alignment
  • Strong analytical and modeling skills, including scenario analysis related to price changes, legislative developments, and IRA exposure
  • Demonstrated success building sustainable controls, audit frameworks, and scalable processes in highly regulated environments
  • Leadership experience managing teams, developing talent, and overseeing vendors or managed service providers
  • Systems acumen, ideally with Model N or similar pricing/contracting platforms, and comfort navigating complex data environments
  • Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time.
Job Responsibility
Job Responsibility
  • Serve as Baxter’s enterprise subject matter expert on government pricing regulations, methodology, and policy interpretation
  • Lead end‑to‑end ownership of AMP, BP, ASP, 340B, and Non‑FAMP submissions, ensuring accuracy, compliance, and timely delivery
  • Advise Commercial, Finance, Legal, Marketing, and Market Access on downstream impacts of pricing strategies, contract structures, and legislative developments
  • Oversee outsourced calculation partners, data inputs, and system outputs, including governance of Model N and other managed service providers
  • Partner closely with Finance and Revenue Accounting to manage reserves, monitor long‑standing accruals, and ensure alignment on financial exposure
  • Lead reconciliation, validation, and audit‑readiness frameworks across all government pricing programs and state transparency requirements
  • Provide support and coordination for the Medicaid rebate process, manage vendor performance, and cash recovery efforts while maintaining strong relationships with CMS, HRSA, VA, DoD, and state agencies
  • Drive process standardization, unbundling initiatives, system modernization, and special projects that shape the future of Baxter’s government pricing function
What we offer
What we offer
  • Support for Parents
  • Continuing Education/ Professional Development
  • Employee Heath & Well-Being Benefits
  • Paid Time Off
  • 2 Days a Year to Volunteer
  • medical and dental coverage that start on day one
  • insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
  • Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
  • 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
  • Flexible Spending Accounts
  • Fulltime
Read More
Arrow Right

Pricing & Revenue Management Operations Director

As the founding leader of the U.S. Contracts & Pricing Execution organization in...
Location
Location
India , Hyderabad
Salary
Salary:
Not provided
amgen.com Logo
Amgen
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s degree and 15+ years of progressive experience in commercial operations, contracts, pricing, finance, accounting, or related operational roles within a U.S. pharmaceutical or biotech environment
  • 8+ years of people leadership experience, including direct management of managers, teams, or complex operational portfolios
Job Responsibility
Job Responsibility
  • Own end-to-end execution of U.S. commercial pricing and payment operations performed in India, ensuring accuracy, completeness, and timeliness of all deliverables
  • Provide leadership and oversight for the operational execution of pricing and rebate programs, including commercial rebate payments, chargebacks processing, Medicaid and Government Pricing processing, and channel fee payment operations that support U.S. commercial revenue management
  • Lead execution of contractually governed and government-impacted commercial processes under tight execution, payment, and reporting timelines with downstream financial reporting impact
  • Drive consistent delivery against defined service levels and quality standards in a highly accountable, deadline-driven environment
  • Establish and monitor operational KPIs, performance metrics, and management reporting to ensure transparency and accountability
  • Provide leadership oversight for revenue management systems supporting U.S. commercial pricing execution, payment processing, and government price calculations, ensuring data integrity, process discipline, and reliable system performance
  • Provide governance and operational leadership for revenue management systems, including Model N, supporting pricing execution, chargebacks processing, commercial rebate payments, Medicaid and Government Pricing processing, and channel fee payment operations
  • Partner with IS and business stakeholders to support system enhancements, defect resolution, upgrades, and process stabilization
  • Ensure revenue management systems are operated with appropriate governance, documentation, and auditability standards
  • Own and maintain SOX-controlled processes associated with pricing and payment execution, including process documentation, evidence standards, certifications, and audit support
Read More
Arrow Right

Health Policy & Reimbursement Executive Director

In this vital role the Health Policy & Reimbursement Executive Director will lea...
Location
Location
United States , Washington D.C.
Salary
Salary:
281425.00 - 325550.00 USD / Year
amgen.com Logo
Amgen
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Doctorate degree & 6 years of health policy or reimbursement experience
  • Master’s degree & 10 years of health policy or reimbursement experience
  • Bachelor’s degree & 12 years of health policy or reimbursement experience
  • 6 years of managerial experience directly managing people and/or leadership experience leading teams, projects, programs or directing the allocation of resources
Job Responsibility
Job Responsibility
  • Lead development and implementation of reimbursement strategies for federal (US) payer issues across multiple therapeutic areas and the company’s biosimilar portfolio
  • Work cross-functionally to help identify and resolve barriers to entry for pipeline products/ therapies and provide broad reimbursement-related advice for inline products, including mitigation strategies in response to proposals that would negatively affect access of Amgen therapies for patients
  • Manage broader health policy efforts including reviewing and analyzing complex policy proposals including regulatory proposals and legislative text, and promptly and concisely communicating impact of these proposals to key internal audiences (government affairs, commercial, regulatory, clinical, and senior executives)
  • Collaborate with government affairs staff to ensure alignment of strategy, talking points and messaging to constituents (elected officials/leaders, agencies, third parties, etc.)
  • Play a key role in health policy engagement with major trade associations on corporate policy priorities which include Amgen specific priorities as well as industry-wide priorities including, but not limited to, Federal drug pricing policy
  • Conduct research and integrate clinical, market and payer data to inform engagement on reimbursement objectives
  • Regularly update via written and oral communications to senior executives and other key partners on various reimbursement and US health policy topics
What we offer
What we offer
  • Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
  • A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
  • Stock-based long-term incentives
  • Award-winning time-off plans and bi-annual company-wide shutdowns
  • Flexible work models, including remote work arrangements, where possible
  • Fulltime
Read More
Arrow Right

Senior Reimbursement Analyst

Senior Reimbursement Analyst role focusing on government payor programs, revenue...
Location
Location
United States , Milwaukee
Salary
Salary:
41.10 - 61.65 USD / Hour
advocatehealth.com Logo
Advocate Health Care
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree in Finance or related field
  • Typically requires 5 years of experience in reimbursement that includes experiences in preparation of Medicare/Medicaid cost reports, regulations and the analysis, modeling and reporting of third party payers
  • Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting
  • Knowledge and understanding of third party regulations and the interrelationship of financial statements
  • Strong accounting background with experience in preparing and/or reviewing health care financial statements
  • Strong proficiency in the use of the Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools or similar products
  • Proficiency in data mining and analysis
  • Excellent written and verbal communication skills
Job Responsibility
Job Responsibility
  • Plans and prepares revenue analysis for system wide programs, projects and services, and monitors revenue budgets and benchmarking activities
  • Identifies and researches opportunities to enhance revenue and improve administrative efficiency of governmental payor programs
  • Reviews government agency bulletins, publications, and the Federal Register to understand proposed and actual state and federal government statutory and regulatory changes
  • Serves as one of the Aurora representatives on the state Medicaid Hospital Rate Advisory Group, Health Care Quality Coalition, and Wisconsin Hospital Association Medicaid Advisory Group
  • Provides support as needed to Finance and Operations on reimbursement related matters
  • Prepares and/or provides necessary information required for the completion of the annual Medicare and Medicaid interim and year-end cost reports
  • Develops and provides coordination for the system-wide monthly closing process with respect to Medicare/Medicaid liabilities
  • Monitors processes to ensure accurate payment for Medicare/Medicaid and monitors interim payments
  • Works with Graduate Medical Education programs to ensure proper Medicare and Medicaid reimbursement
What we offer
What we offer
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program
  • Fulltime
Read More
Arrow Right

Senior Reimbursement Analyst

Senior Reimbursement Analyst role focusing on government payor programs, revenue...
Location
Location
United States , Milwaukee
Salary
Salary:
41.10 - 61.65 USD / Hour
advocatehealth.com Logo
Advocate Health Care
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree in Finance or related field
  • Typically requires 5 years of experience in reimbursement that includes experiences in preparation of Medicare/Medicaid cost reports, regulations and the analysis, modeling and reporting of third party payers
  • Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting
  • Knowledge and understanding of third party regulations and the interrelationship of financial statements
  • Strong accounting background with experience in preparing and/or reviewing health care financial statements
  • Strong proficiency in the use of the Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools or similar products
  • Proficiency in data mining and analysis
  • Excellent written and verbal communication skills
Job Responsibility
Job Responsibility
  • Plans and prepares revenue analysis for system wide programs, projects and services, and monitors revenue budgets and benchmarking activities
  • Identifies and researches opportunities to enhance revenue and improve administrative efficiency of governmental payor programs
  • Reviews government agency bulletins, publications, and the Federal Register to understand proposed and actual state and federal government statutory and regulatory changes
  • Serves as one of the Aurora representatives on the state Medicaid Hospital Rate Advisory Group, Health Care Quality Coalition, and Wisconsin Hospital Association Medicaid Advisory Group
  • Provides support as needed to Finance and Operations on reimbursement related matters
  • Prepares and/or provides necessary information required for the completion of the annual Medicare and Medicaid interim and year-end cost reports
  • Develops and provides coordination for the system-wide monthly closing process with respect to Medicare/Medicaid liabilities
  • Monitors processes to ensure accurate payment for Medicare/Medicaid and monitors interim payments
  • Works with Graduate Medical Education programs to ensure proper Medicare and Medicaid reimbursement
What we offer
What we offer
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program
  • Fulltime
Read More
Arrow Right