Director, Managed Care Group
Center for Medicaid and CHIP Services (CMCS)
Centers for Medicare & Medicaid Services
John Giles is currently the Director of the Managed Care Group (MCG) within the Center for Medicaid and CHIP Services (CMCS) at the Centers for Medicare & Medicaid Services (CMS). John leads and directs all of the Medicaid managed care policy and operations across several primary portfolios of work, including Medicaid managed care policy development, delivery system and provider payment initiatives (State directed payments), in lieu of services and settings (ILOS), capitation rate development, Medicaid managed care medical loss ratios (MLRs), Federal Medicaid managed care authorities, managed care plan contract oversight, Medicaid managed care program monitoring and oversight, and Medicaid managed care strategy and performance management.
John leads and directs CMS’s work on all aspects of the nation’s Medicaid managed care delivery system. John oversees the development of oversight tools for monitoring, proposes rules and policy to enhance managed care delivery, and collaborates with managed care plans, providers, states, and other stakeholders to ensure that Medicaid beneficiaries who receive their Medicaid benefits through managed care have a seamless experience. John leads the Managed Care Group to establish program policy that ensures high quality of care and prudent financial accountability across the nation’s Medicaid managed care programs.
Prior to joining CMS, John served in a mix of leadership roles for the State of Oklahoma, including as the Director of the Center for Health Innovation and Effectiveness for the Oklahoma State Department of Health and Senior Policy Advisor for the Oklahoma Health Care Authority. John has more than 20 years of experience in Federal and State Medicaid policy and operations. John received a Master of Public Administration (MPA) from the University of Oklahoma and a Bachelor of Arts (BA) from the University of Central Oklahoma.