Medicaid, SME

Position Summary

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.

Key Duties and 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 functions 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.

Minimum Qualifications

• 15+ years of relevant experience that demonstrates progressive responsibility including
• 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 fast-paced environment with tight deadlines
• Excellent oral and written communication skills
• Requirement to be at on-site client location 4-5 days a week with 50% travel.

Preferred Qualifications

• Familiarity with a managed care operating model
• Project management experience and PMP certification
• 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

*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job.  Duties, responsibilities and activities may change at any time with or without notice.

Working Conditions/Physical Effort

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift 15 pounds at times.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at -, and we would be happy to assist you.

Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before.

We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American

We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more

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