ANALYTICA is seeking a State Medicaid Program Integrity Director/SME to provide oversight support on a Medicaid program integrity audit/review program covering 30+ states. The Program Director shall have deep programmatic and program integrity understanding and knowledge around (1) program integrity monitoring; (2) federal oversight of state Medicaid managed care programs and technical assistance to support improvements; and (3) comprehensive fraud risk assessment methodologies and practices.
Primary Responsibilities may include:
- Act as the client point of contact for day to day projects, activities may include leading customer interaction, managing progress communications, resolving any potential issues, mitigating risks, develop, organize, and manage risks, action items, change control, and communication plans
- May be tasked to oversee a range of project sizes, from small to mid-scale project delivery (ranging from 1 - 30 FTEs), leading cross-functional technical teams to deliver projects within the constraints of quality, scope, schedule, and budget
- Engage functional corporate support teams (such as staffing, finance, etc.) to ensure projects are exceeding requirements and are delivered at an exceptional service level, on time and on budget.
- Participate in federal capture activities, such as proposal development, opportunity identification, and client meetings
- Facilitate team’s work by leveraging understanding of stakeholders when interfacing with CMS, state, or other stakeholders as needed, such as to remove potential roadblocks
- Provide unique and valuable insights and help resolve protocol issues through extensive domain knowledge and a keen understanding of CMS Program Integrity broader goals, needs, and constraints.
- Ability to enable and harness team’s skills and talents to successfully accomplish PI reviews
- Capabilities to conduct desk reviews on State program integrity activities related to the Opioid crisis
- Experience working with managed care, beneficiary eligibility, and opioids, as well as a broad range of Medicaid topics that may be prioritized in future review activities
- Extensive program management skills to manage resources and ensure staff are effectively utilized across multiple, sometimes overlapping focused reviews across various states
- 5+ years in a Director role at both state-level and federal-level Program Integrity offices or initiatives
- 7+ years in management capacity or with Project Management experience where responsible for managing complex systems and workflows
- Bachelor’s degree from an accredited institution
- Ability to extract meaning from complex information
- Strong Medicaid program and policy background with experience at the federal and/or state level
- Strong Medicaid program integrity background with oversight experience at the federal and/or state level
- Extensive Medicaid program integrity subject-matter and analytics expertise, ideally including managed care program integrity or oversight experience
- Ability to work in a fast-paced, small business environment that may entail cross functional support and late nights or weekends when required
- Solution-oriented work style with a focus on results and willingness to deliver
- Expertise in conducting oversight activities of states and performing risk assessments of government programs
- Experience around principles for identifying Medicaid vulnerabilities and mitigating improper payments and waste, fraud, and abuse
- Experience working with managed care, beneficiary eligibility, and opioids, as well as a broad range of Medicaid topics
About ANALYTICA: Analytica is a leading consulting and information technology solutions provider to public sector organizations supporting health, civilian, and national security missions. Founded in 2009 and headquartered in Washington D.C., the company is an established SBA certified HUBZone and 8(a) small business that has been recognized by Inc. Magazine each of the past three years as one of the 250 fastest-growing companies in the U.S. Analytica specializes in providing software and systems engineering, information management, analytics & visualization, agile project management, and management consulting services. The company is appraised by the Software Engineering Institute (SEI) at CMMI® Maturity Level 3 and is an ISO 9001:2008 certified provider.