IT - SCDHHS - IT Healthcare Consultant - Project Manager - Consultant

SCOPE OF THE PROJECT

SCDHHS is looking for an IT Healthcare Consultant
- Project Manager
- Consultant who will be the lead for MMIS Medicaid Systems Operational Management. This position will lead teams that support business-critical operations for MCO enrollment, claims and encounter processing and payment and other support functions.

• Oversee, coordinate, and perform operations and support activities for MMIS, Encounter Processing System, and other supporting systems. To include communication and coordination with vendors, Office of Cyber Security, Enterprise Architecture, etc.
• Maintains an effective organizational team and motivates diverse staff to accomplish mission critical operations and objectives. These teams provide production support, helpdesk, interface/EDI support, and stakeholder monitoring.
• Oversee incident and issue management. Ensures documentation, tracking, escalation, and resolution for all ticket types. Ensures timely resolution of production issues.
• Identifies and mitigates operational issues and ensures decisions and actions are well-documented.
• Handles internal and external escalations and requests and ensures they are satisfactorily resolved, communicating issues and outcomes to appropriate personnel. Ensures work is assigned appropriately and escalations are resolved in a timely and effective manner.
• Ensures compliance with security (CMS, SSA, etc.) and monitors all findings and recommendations to completion.
• Works with contract monitor to ensure SLAs are set and monitored.
• Responds promptly to inquiries.
• Promotes workforce engagement and a safe, professional, and productive work environment for all team members.
• Implements, monitors and follows Standard Operating Procedures and alerts team when practice differs from SOP.
• Oversees release management activities stakeholder communication, pre-implementation planning, readiness checks, and post-implementation monitoring.
• Provide support to change management by performing and coordinating backlog grooming and maintenance and ensuring compliance with appropriate approval gates.

• Bachelor's degree in a technical, business, or healthcare field. 5+ years of equivalent experience in business/systems analysis and/or computer systems development/modification may be substituted.
• 5+ years of prior experience managing system operations and or administrative program functions for claims and/or encounter processing in healthcare environment.
• 5+ years of experience in project management – managing system implementations or enhancements.
• 3+ years of experience manage external vendors who provide system development.
• Ability to provide incident management on call and after hours.

• Prior experience managing operations of Medicaid Enterprise systems.
• Ability to make presentations and prepare reports.
• Knowledge of Medicaid eligibility, enrollment, and MMIS domain concepts.
• Experience with ticketing software.
• Experience with writing standard operating procedures for new system implementations.
• AWS Cloud Certifications.