Medicaid Subject Matter Expert - pro it

Job Summary:

We are seeking a highly knowledgeable and experienced Medicaid Subject Matter Expert (SME) to join our team. The SME will play a crucial role in the development, implementation, and optimization of our case management solutions tailored for Medicaid programs. This role requires deep expertise in Medicaid regulations, policies, and operational processes, as well as a strong understanding of case management practices.

Key Responsibilities:

· Expert Consultation: Provide expert guidance and insights on Medicaid policies, regulations, and best practices to inform the design and implementation of case management solutions.

· Solution Development: Collaborate with product development teams to ensure that the case management solution meets the specific needs and requirements of Medicaid programs.

· Process Optimization: Identify opportunities to enhance the efficiency and effectiveness of case management processes within Medicaid programs.

· Stakeholder Engagement: Work closely with internal and external stakeholders, including healthcare providers, government agencies, and other relevant organizations, to ensure alignment and compliance with Medicaid standards.

· Training and Support: Develop and deliver training programs for internal teams and end-users to ensure proper understanding and utilization of the case management solution.

· Compliance Monitoring: Stay current with changes in Medicaid regulations and ensure that the case management solution remains compliant with all relevant laws and guidelines.

· Documentation: Create and maintain comprehensive documentation on Medicaid requirements, processes, and best practices as they relate to case management.

Qualifications:

· Education: Bachelor’s degree in Healthcare Administration, Public Health, Social Work, or a related field. Master’s degree preferred.

· Experience: Minimum of 5 years of experience working with Medicaid programs, including in-depth knowledge of Medicaid policies, regulations, and case management practices.

· Expertise: Strong understanding of Medicaid case management processes, including eligibility, enrollment, care coordination, and utilization management.

· Skills:

o Excellent analytical and problem-solving skills.

o Strong communication and interpersonal abilities.

o Ability to work collaboratively with cross-functional teams.

o Proficiency in using case management software and tools.

· Certifications: Relevant certifications in Medicaid, healthcare management, or case management are a plus.