California Enhanced Aligned Enrollment EAE program

Overview

Remote
Depends on Experience
Full Time

Skills

Medicaid
FDE
CA EAE

Job Details

Must Have Technical/Functional Skills
Act as the primary SME for CA EAE requirements, including eligibility, claims routing, provider data, and compliance.
Advise on system architecture and integration for EAE-related enhancements (e.g., ADT file exchange, risk stratification, retro rate management).
Collaborate with architects and IT teams to design solutions that meet DHCS and CMS requirements.
Support end-to-end reviews of Medicaid rate update capabilities, identifying gaps and recommending improvements.
Ensure documentation, audit trails, and compliance controls are in place for all EAE processes.
Provide guidance on workflow, task management, and communication systems supporting EAE operations.
Participate in project planning, testing, and readiness activities for EAE initiatives.
Roles & Responsibilities
Key Responsibilities
Act as the primary SME for CA EAE requirements, including eligibility, claims routing, provider data, and compliance.
Advise on system architecture and integration for EAE-related enhancements (e.g., ADT file exchange, risk stratification, retro rate management).
Collaborate with architects and IT teams to design solutions that meet DHCS and CMS requirements.
Support end-to-end reviews of Medicaid rate update capabilities, identifying gaps and recommending improvements.
Ensure documentation, audit trails, and compliance controls are in place for all EAE processes.
Provide guidance on workflow, task management, and communication systems supporting EAE operations.
Participate in project planning, testing, and readiness activities for EAE initiatives.

Qualifications:

5+ years of experience in Medicaid operations, with a focus on California programs.
Working knowledge of system architecture, data integration, and healthcare compliance.
Experience with claims, eligibility, provider, and reporting systems in a managed care environment
Generic Managerial Skills, If any
Collaborate with Project stakeholders and Drive the team to complete the deliverables
Proven success working in large Medicare FDE programs
Expertise in solving complex business functional issues, and manage the stakeholders.
Team management

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.