Medicaid Project Manager

3- 7 years of experience in the field or in a related area. Familiar with standard concepts, practices, and procedures within a particular field. Relies on limited experience and judgment to plan and accomplish goals. A certain degree of creativity and latitude is required. Works under limited supervision with considerable latitude for the use of initiative and independent judgment. Minimum of three (3) years of progressive broad-based information systems, system integration and project delivery experience. Experience working with external vendors and/or Quality Assurance efforts a plus.

Project managers are the people in charge of a specific project or projects within a company. As the project manager, your job is to plan, budget, oversee and document all aspects of the specific project you are working on. Project managers might work by themselves or be in charge of a team to get the job done. Project Management Professional (PMP) certification is required and should be noted on the resume. Proof of certification may be requested.

The Provider Services unit (formerly Operations Management Claims Administration) supports Medicaid and CHIP Services (MCS) providers with Fee-for-Service (FFS) claims management, support, and administrative appeals for both long-term care, and acute care; provider enrollment; and Electronic Visit Verification (EVV).

A Project Manager (PM) is needed to manage the Provider Enrollment and Management System (PEMS) Plus Credentialing project. Providers must be enrolled to deliver services to Medicaid clients and receive payment from HHSC or the Medicaid Managed Care Organizations (MCO) and/or the Dental Maintenance Organizations (DMO). In addition to Medicaid enrollment, providers must also be credentialed by the MCOs and DMOs that they contract with. The credentialing process ensures providers have appropriate qualifications to provide the services they are contracting for. For example, a physician s license would be verified through the credentialing process. This project will ensure the credentialing process is fully integrated into the PEMS application to streamline provider enrollment and reduce the number of steps providers must take to get enrolled and credentialed.

The worker will serve as a Project Manager for the PEMS Plus Credentialing project and support activities as needed. The worker will manage and lead the project of integrating the credentialing application used by MCOs/DMOs into PEMS. The worker will report to governance committees on the activities of the project. The worker will identify, record, and ensure trading partners are aware of critical path dependencies, integration points and oversee testing plans. The worker will work closely with the Director of Provider Services, and the Deputy Associate Commissioner for MCS Operations Management. This Project Manager will oversee and lead the work of other project staff to ensure tasks are assigned, tracked and completed timely and accurately.

The worker will be responsible for delivering quality products that meet the state's desired operational and technical requirements. The worker will have considerable latitude to use their experience and judgement to ensure successful completion of their assigned tasks. The worker will be required to multi-task, analyze priorities, communicate clearly, and set expectations for the phases of the project. The worker will be responsible for communicating with multiple internal and external stakeholders including program and technical staff, and other contracted and vendor resources. The worker will participate in meetings, track deliverables and schedules, and alert management of any issues that may impact providers.

The services to be provided include, but are not limited to the following:

Coordinating duties and responsibilities with PEMS Sprint Teams and Provider Services.

Development, maintenance, and monitoring of integrated project timelines in coordination with PEMS project timelines.

Ensuring that the project plan maintains tasks, schedules, and status updates as well as disseminating information to team members.

Oversight and reporting of critical path dependencies between PEMS projects.

Communicating project status, issues, and risks to department management, HHSC vendors, Provider Services and PEMS sprint teams. Developing mitigation plans as necessary.

Communicating status of program initiatives to department management and other impacted stakeholders.

Planning and managing efficient project meetings and documenting key decisions.

Designing strategies to mitigate or avoid identified project risks and difficulties.

Years | Required/Preferred | Experience
8 | Required | Experience in management of large-scale IT projects, including system integration, resource management, procurement transition and vendor management.
7 | Required | Experience with Medicaid Enterprise Systems, including Medicaid Management Information Systems (MMIS).
7 | Required | Ability to identify problems, evaluate alternatives, and implement effective solutions; to develop and evaluate policies and procedures; to prepare reports.
7 | Required | Demonstrated ability to meet tight deadlines.
7 | Required | Experience with Medicaid business operations.
7 | Required | Experience overseeing the planning and execution of major projects, including facilitation and documentation of high-level critical path dependencies across multiple projects.
7 | Required | Experience successfully leading meetings and facilitating discussions between multiple stakeholder groups, including vendors.
7 | Required | Expertise using Microsoft Office products: Teams, Word, Excel, PowerPoint, Project, Outlook.
7 | Required | Ability to establish project goals and objectives that support the state and HHS strategic plans as well as federal directives.
7 | Required | Proven ability to work successfully with technical and non-technical groups and manage multiple responsibilities.
7 | Required | Excellent analytical, problem-solving, and coordination skills.
7 | Required | Experience and judgment to plan and accomplish goals and independently perform a variety of complicated tasks; a wide degree of creativity and latitude is expected.
7 | Required | Oral and written communication skills.
4 | Required | Required certification in Project Management by a recognized project management organization.
3 | Preferred | Knowledge of Medicaid programs.
2 | Preferred | Experience with Health and Human Services programs.
2 | Preferred | Experience with provider enrollment systems.
1 | Preferred | Scrum Master certification preferred.