Medicaid Data Strategy Consultant

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

We are seeking strong consultants with experience and knowledge of national healthcare reform and its impact on state Medicaid public health or state and local health and human services programs including Medicaid Systems Medicaid policy Medicaid managed care Medicaid program operations program improvement and state compliance requirements as well as a strong understanding about various state and local programs and policies across the country. The successful candidate will:

• Understand CMS guidelines federal and state compliance standards and how they should be reflected in Medicaid system design and deployment.
• Independently assess and interpret MMIS-related technical documentation (e.g. system design documents interface control documents configuration documents and traceability matrices) ensuring completeness consistency and alignment with Medicaid program needs.
• Participate in MMIS system design reviews and technical discussions offering critical insights based on a deep understanding of Medicaid systems architecture and common risk patterns.
• Evaluate requirements traceability ensuring technical and functional requirements are accurately linked to design development testing and deployment artifacts.
• Support testing lifecycle assessments including review of system integration testing user acceptance testing (UAT) and end-to-end testing strategies and execution. Identify gaps and prioritize concerns based on risk coverage and readiness.
• Contribute to data conversion and migration assessments including evaluation of mapping cleansing and validation activities across key modules such as provider member claims and prior authorization.
• Translate complex technical and system implementation issues into documented actionable insights for diverse stakeholders ranging from Medicaid program staff to system vendors and internal leadership.
• Collaborate with state agencies (including Medicaid Behavioral Health Intellectual and Developmental Disabilities State Units on Aging and/or Social/Human Services) to support system modernization and business transformation efforts.
• Perform quantitative data analysis and qualitative research activities to address state research needs
• Research and stay abreast of all states healthcare transformation efforts
• Manage discrete projects or task areas contribute to client deliverables and support ongoing engagement execution.
• Supervise and support the development of staff
• Effectively manage client interaction and manage client expectations
• Provide subject matter expertise as requested and appropriate
• Assist in proposal development and business development efforts including identifying new opportunities and supporting pursuits with technical insights.
• Participate in non-client-related firm-building activities
• Participate in analysis of client-identified issues or problems

What You Will Need:

• Requires a University Degree and a minimum of 5-7 years of prior work experience
• Experience of 27 years supporting large-scale healthcare IT programs or consulting experience including at least 2 years supporting Medicaid MMIS implementations or Maintenance and Operations (M&O).
• Familiarity with Medicaid regulations CMS guidelines and state compliance requirements.
• Strong understanding of Medicaid system modules including eligibility claims processing provider enrollment member management prior authorization and other subsystems.
• Demonstrated ability to critically assess system documentation and implementation approaches with minimal supervision.
• Strong analytical and writing skills including experience developing and delivering client-ready technical assessments and findings.
• Ability to travel to meet client needs (10-30%) as required
• Excellent analytical problem-solving and communication skills

What Would Be Nice to Have:

• Experience performing IV&V System Integrator or MMIS implementations/M&O on Medicaid systems
• Direct experience working with or reviewing the work of MMIS vendors.
• Knowledge of state health agencies and healthcare reform e.g. Medicaid public health health insurance and health reform organizations (legislative executive governors office)
• A masters degree in an IT business or health-related field
• Familiarity with Agile methodologies and SDLC
• A strategic problem solver
• Demonstrated ability to self-manage task execution and manage discrete task / project / initiative functions.
• Proficiency with project collaboration tools Microsoft Suite (Word Excel PowerPoint) and ability to synthesize research and technical documentation effectively.
• The ability to work overtime as necessary
• Assure high-quality client-ready work product

What We Offer:

Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical Rx Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave and Adoption Assistance

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Student Loan PayDown

• Tuition Reimbursement Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

• Mobility Stipend

About Guidehouse

Guidehouse is an Equal Opportunity EmployerProtected Veterans Individuals with Disabilities or any other basis protected by law ordinance or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.