Location: Columbia SC
Duration: 12 months
Positions: 1
Important:
• This position requires Medicaid policy knowledge with additional
experience in MMIS implementations.
• should be so strong in their business knowledge that they could
perform end user business duties with minimal training.
• focusing more on the following subject matter areas:
o Medicaid policy and reference data management
o Clinical background
o CMS system certification
DAILY DUTIES / RESPONSIBILITIES:
A Replacement MMIS Subject Matter Expert (SME) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. The majority of the system development work will be outsourced to vendors and other State organizations.
Duties include:
• Requirements development execution, including the elicitation,
analysis, specification and validation.
• Documenting and analyzing agency business processes and recommending
improvements.
• Documenting and analyzing data requirements and relationships.
• Participate in the requirements management processes, including
change control; version control; tracking and status reporting; and traceability.
• Providing requirement interpretation and guidance to technical and
test teams.
• Proactively identifying risks, issues, and action items leading to
possible solutions.
• Interacting with internal and external organizations (i.e. vendors,
State and Federal government agencies, State providers and beneficiaries, and other stakeholders).
• Participating in standup of business operations supporting the
Replacement MMIS.
• Planning for, conducting, and reporting on testing and other quality
assurance activities.
• Other related activities.
Client is seeking a SME with the business expertise and operations experience, information technology project experience, and interpersonal skills necessary to enable success on this high- visibility project. Subject matter areas must include medical policy (supported by a clinical background, if possible) and reference data management.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Strong background and at least ten years experience in Medicaid
business operations (state and vendor side experience preferred).
Experience in multiple business areas is a plus. Note: IT operations are not the same as business operations.
• Experience working for a state Medicaid agency, a Medicaid fiscal
agent vendor, or CMS. Experience with more than one of these organizations is a big plus.
• At least three years experience in healthcare insurance IT software/
systems implementations and operations.
• Ability to properly document business requirements.
• Ability to interpret business process and business data models.
• Vendor management experience.
• Superb written and oral communications skills, including the ability
to give presentations to executive management. Strong proficiency in English is required.
• Impeccable integrity. This project will have very high visibility
and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
• Willingness and ability to effectively engage with people and
organizations on a continuous basis. PREFERRED SKILLS (RANK IN ORDER
OF IMPORTANCE):
• Understanding of the Medicaid Enterprise Certification Toolkit
(MECT). Experience in certification from the state or CMS side is strongly preferred.
• Understanding of the Medicaid Information Technology Architecture
(MITA).
• Nursing background is preferred.
• Public sector procurement experience is a plus.
REQUIRED EDUCATION:
Bachelors degree. A degree in nursing is a plus.
REQUIRED CERTIFICATIONS:
A nursing license from any state is a plus.
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