Eligibility Policy Program Manager (HCPM/AHEA)

Description

Eligibility Policy Program Manager (Health Care Program Manager) This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs. All HCA employees are required to be Washington state residents upon their first day of employment. The Opportunity Be the agency's go-to expert on how Washington residents keep their Apple Health coverage. As the Eligibility Policy Program Manager in the Eligibility Policy Innovation and Community Support (EPICS) section, you will lead statewide policy for Apple Health renewals, ex parte renewals, and change of circumstances across all 65 programs. You will translate federal and state requirements into clear, workable policy that protects coverage for nearly 2 million Washingtonians and ensures state and federal funds are used appropriately.

Key Responsibilities

• Serve as the subject matter expert in Apple Health eligibility renewal policy, ex parte renewals, and change of circumstances, leading the analysis and maintenance of current and changing policy across all 65 programs with working knowledge of all statewide Apple Health eligibility policy.
• Collaborate with federal partners, community partners, staff, and system partners to build shared understanding and implementation of initiatives that impact renewal cycles and compliance.
• Coordinate and lead workgroups with business partners to develop eligibility processes that comply with federal and state policy.
• Coordinate monthly Centers for Medicare & Medicaid Services (CMS) meetings to ensure HCA follows Medicaid and Title XXI/CHIP requirements.
• Translate federal policy and guidance into statewide Apple Health policy through Washington Administrative Code (WAC) development and adoption; develop and clarify policy and procedures for legislative staff, constituents, state agencies, HCA staff, and community-based organizations.
• Lead and manage partner relations to implement necessary changes with federal partners, community assisters, providers, legal advocates, Tribal partners, and other interested parties.
• Respond to legislative and constituent inquiries and review legislative bills with potential impacts to Apple Health, making recommendations consistent with strategic long-range plans.
• Direct the implementation of policy, negotiate with partners on behalf of the agency, and serve as a regional point of contact on policy and implementation guidelines.
• Analyze agency policy and operations, develop proposals for executive management, and lead improvements to case processing, workflows, and eligibility determinations.
• Train staff and community partners on Apple Health policy and present to partners and leadership through webinars, meetings, and conference calls.

Why You’ll Love This Role

• Your expertise will directly protect continuous health coverage for Washington residents at every renewal.
• You'll work at the intersection of federal guidance, state rulemaking, and community implementation.
• You'll have real influence, presenting proposals to executive leadership and shaping statewide policy.
• You'll collaborate with CMS, partner agencies, Tribal partners, and community organizations across the state.

What You Bring You are a policy expert who can untangle complex federal and state requirements and turn them into clear, practical guidance. You think strategically about long- and short-range plans while staying responsive to day-to-day issues, and you resolve complex problems independently while knowing when to involve leadership. You are a confident communicator and negotiator who builds trust with partners, uses human-centered design, and applies an equity lens to policy development. Required Qualifications Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter, resume, and application.

• Health Care Program Knowledge: Demonstrated knowledge of health care delivery systems, public health programs, and applicable federal and state requirements to support effective program administration.
• Program Planning and Implementation: Demonstrated experience developing, implementing, monitoring, and evaluating health care programs, policies, and operational initiatives to achieve established objectives.
• Policy and Regulatory Interpretation: Demonstrated expertise interpreting and applying laws, administrative rules, policies, and contractual requirements to complex program issues.
• Strategic Analysis and Decision-Making: Demonstrated skill in analyzing program data, assessing risks and operational impacts, and developing informed recommendations for management decisions.
• Partner Collaboration: Demonstrated experience establishing and maintaining productive relationships with agencies, health care providers, community organizations, and other partners to advance shared program goals.
• Communication and Consultation: Demonstrated skill in communicating complex health care program information clearly and providing sound technical guidance to leadership, staff, and external partners.
• Equitable Service Delivery: Demonstrated understanding of barriers to health care access and approaches that support responsive, inclusive, and culturally appropriate services.
• Leadership and Organizational Coordination: Demonstrated experience coordinating cross-functional activities, setting priorities, and supporting staff and partners through operational or policy changes.
• Problem Resolution and Continuous Improvement: Demonstrated sound judgment in resolving complex program concerns, balancing competing priorities, and implementing practical improvements consistent with program requirements.

Required Competencies

• Equity lens – All HCA employees are required to consider equity in their decisions, processes, and day-to-day work, including how their work may affect the people and communities we serve.
• The ability to take action to learn and grow – You take action to learn and grow by seeking new perspectives, learning from experiences, and using what you’ve learned to continuously improve how you work and serve others.
• The ability to take action to meet the needs of others – You take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve.

Preferred Qualifications While these are not required, having them may help you stand out as an applicant.

• Demonstrated professional experience providing consultation or supervision in health services, social services, Medicaid, behavioral health, or other health care programs.
• Effective written and verbal communication skills, including public speaking, partner engagement, leadership, strategic planning, project management, and independent decision-making when interacting with agency leadership, professional organizations, community partners, and other interested parties.
• Demonstrated knowledge of Washington State government structure, agency functions, and Apple Health (Medicaid) policies, procedures, and services to support effective administration and delivery of medical assistance programs.
• Experience interpreting and applying state and federal laws, regulations, policies, and procedures governing Medicaid, health care reform, and the administration and delivery of medical assistance programs.
• Experience researching, developing, drafting, and evaluating Medicaid policies and procedures; analyzing policies and practices in other states; developing short- and long-term program strategies; and assessing program implementation for compliance with applicable legal and regulatory requirements.
• Experience conducting complex research and analysis of Medicaid systems, program data, legislation, fiscal constraints, and other relevant information to identify issues, evaluate alternatives, and recommend solutions related to Medicaid and state-funded medical program eligibility policies.
• Experience developing and delivering educational materials, presentations, and technical guidance regarding federal Medicaid and state-funded medical program eligibility policies and services to community organizations, partners, legislators, and other audiences.
• Demonstrated proficiency in management principles, organizational practices, collaborative problem-solving, conflict resolution, negotiation, and decision-making to support effective program operations and organizational objectives.
• Demonstrated proficiency in Microsoft Office applications, databases, spreadsheets, and information management systems, including ACES, Barcode, ProviderOne, Washington Healthplanfinder, and other relevant systems to research, analyze, and manage program information.
• A master's degree in public health, behavioral health, public administration, business administration, social work, or a closely related field.

About the Apple Health Eligibility and Access Division The Apple Health Eligibility and Access (AHEA) Division works across HCA and in partnership with the health care community at the local, state, and federal levels to develop and manage high-quality, evidence-based health care programs and purchase services that enhance Washington residents' ability to access appropriate, quality health care. Within AHEA, the Eligibility Policy Innovation and Community Support (EPICS) section evaluates federal statutes and regulations, sets state policy for Apple Health eligibility, and represents the agency in communities across the state, supporting the nearly 2 million Washington residents who rely on Apple Health for affordable medical services. Supplemental Information About the Washington State Health Care Authority Better Health. Better Care. A Healthier Washington. At HCA, we work to ensure people across Washington have the opportunity to be as healthy as possible. As the State’s largest health care purchaser and behavioral health authority, HCA serves nearly 3 million Washington residents through Apple Health (Medicaid), Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs, and behavioral health services. Through this work, HCA purchases and coordinates care coverage, supports behavioral health prevention, treatment, crisis response, and recovery and helps strengthen access to high-quality care across Washington.

More than a benefits package:

We want our employees to have the support, flexibility, and benefits they need to do their best work and build a career that works for their life. As a Washington State HCA employee, you’ll have access to a comprehensive benefits package that supports your health, financial well-being, and work-life balance. Our benefits are designed to support you today while helping you plan for the future. Learn more about why HCA by visiting the Voices of HCA and the "Who we are" section of our website.

Your total compensation is more than your paycheck:

• Remote work and flexible schedules
• Medical, dental, vision, and basic life insurance
• Paid vacation, sick leave, and 12 paid holidays
• Paid Family and Medical Leave (PFML)
• Retirement options to plan for the future
• Training and professional development opportunities
• Employee wellness programs
• Learn more about Washington State Employee Benefits

Work Location and Schedule This is a full-time 40-hour-per-week remote position. Our standard business hours are Monday through Friday, 8 a.m. to 5 p.m., with alternative work schedules considered based on business needs and supervisor approval. In this role you will regularly collaborate with colleagues, agency leaders, state and federal partners, and other external partners or customers. Occasional travel may be required for meetings, training, or other business needs. All employees are required to report to our Olympia office on their first and final day of employment. Our commitment to an inclusive workplace: The Health Care Authority is an equal opportunity employer. We are committed to creating a workplace where employees are respected, included, and supported in bringing their experiences, perspectives, and ideas to work. Our commitment to inclusion is reflected in how we work together and serve the people of Washington. HCA also supports five voluntary employee led Employee Resource Groups (ERGs), which create opportunities for connection, community, learning, and professional growth. Application Directions To be considered, you must complete the online application in full and submit all required materials. Incomplete applications or applications missing required materials will not be considered. When completing your application, please include the following required materials:

• Cover letter: describing your qualifications for this specific position
• Resume: that details your applicable experience and education.
• Three (3) professional references: References must be entered directly into the designated references section of your application. We require 3 professional references including at least one current or recent supervisor.

We encourage you to apply! If you meet the required qualifications for this position; we want to hear from you. Desired qualifications describe additional experience, knowledge or skills that may be helpful in the role, but they are not required to be considered for the position. We welcome applicants with different backgrounds, experiences, identities, and perspectives. Veterans: We value the experience and skill veterans bring to the workforce and encourage veterans, transitioning service members, and military spouses to apply. Eligible veterans may qualify for veterans’ preference in accordance with Washington State Law. If you are claiming veterans’ preference, you must attach your applicable DD-214 documentation to your application. Please redact your social security number, date of birth, and any other sensitive information before uploading and attaching the document. Need accommodations or have questions? If you have questions, need assistance with the application process, require an accommodation, or would like to request this posting in an alternative format, please contact Lisa Fleming, Human Resource Consultant (Recruiter) at HCAjobs@hca.wa.gov and reference the recruitment title and job number in the subject line. Technical Support: Reach out to NEOGOV directly at 1-855-524-5627 for technical support and login issues. The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify® is a registered trademark of the U.S. Department of Homeland Security.

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Benefits

More than Just a Paycheck! Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.

We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. That's why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.

Read about our benefits:

The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.

Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits.

Insurance Benefits Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.

Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.

To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.

Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.

Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.

The Washington State Employee Assistance Program promotes the health and well-being of employees.

Retirement and Deferred Compensation State Employees are members of the Washington Public Employees' Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems' web site.

Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.

Social Security All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.

Public Service Loan Forgiveness If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.

Holidays Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.

Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.

Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.

Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.

Sick Leave Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave.

Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.

Vacation (Annual Leave) Full-time employees accrue vacation leave at the rates specified in WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.

Part-time employees accrue vacation leave hours in accordance with WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.

Pay status includes hours worked, time on paid leave and paid holiday.

As provided in WAC 357-58-175, an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.

Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.

Military Leave Washington State supports members of the armed forces with 21 days paid military leave per year.

Bereavement Leave Most employees whose family member or household member dies, or for loss of pregnancy, are entitled to five (5) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.

Additional Leave Leave Sharing Parental Leave Family and Medical Leave Act (FMLA) Leave Without Pay

Please visit the State HR Website for more detailed information regarding benefits.

Updated 01-07-2026