Medicaid, SME

Zenith American Solutions•Remote - PST - Zone 5, AZ

2d•Onsite

About The Position

The Medicaid SME provides in-depth knowledge and expertise on Medicaid policies, operations, and MMIS functionality to support system management, compliance, and process improvements. This role collaborates with stakeholders to identify solutions, enhance efficiency, and ensure alignment with federal and state regulations. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Requirements

15+ years of relevant experience that demonstrates progressive responsibility.
10+ years of experience in a functional and/or operational management role on an MMIS development or maintenance environment.
Consulting level experience with multiple business areas.
Able to excel in a fast-paced environment with tight deadlines.
Excellent oral and written communication skills.

Nice To Haves

Familiarity with a managed care operating model.
Project management experience and PMP certification.
Bilingual, Spanish language competency.
DDI and operations experience preferred.
Knowledge of Medicaid Information Technology Architecture (MITA) principles and framework.
Knowledge and understanding of the Medicaid Enterprise Certification Toolkit (MECT) checklists.
Willingness and ability to effectively engage with people and organizations on a continuous basis.

Responsibilities

Assists the Medicaid Program staff in the management and operation of the MMIS.
Reviews MMIS issues and helps determine the best solution for resolution.
Provides guidance and direction for PRMMIS day-to-day operations and activities.
Identifies risks and monitors progress of MMIS operations, including Service Level Agreements (SLAs).
Assist in training Medicaid Program staff to manage and operate key functional of the MMIS.
Collaborates with stakeholders, including state agencies, vendors, and providers, to improve system functionality and operational efficiency.
Supports system enhancements, testing, and implementation efforts by providing subject matter expertise on Medicaid program requirements and business processes.
Analyzes Medicaid policy changes and assesses their impact on MMIS operations, ensuring compliance with Federal and State regulations.
Performs other duties as assigned.