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IT Healthcare Consultant - Business Analyst - Consultant
Ref No.: 16-00013
Location: columbia, South Carolina
Start Date: 09/21/2016
SCDHHS is the State Medicaid Agency for South Carolina. This project is focused on the replacement of the State's Medicaid Management Information System (MMIS). The project is a major undertaking for SCDHHS and requires major transformation of culture, processes and technology. This project also supports the Department's transition from primarily a fee-for-service payor of claims towards a program and policy driver for health outcomes primarily through managed care programs.

The Replacement MMIS project is a multi-year effort to replace the State's aging MMIS and related applications with more modern capabilities along with corresponding business operations services. 

The goal of the RMMIS program will be incremental and modular in nature with a focus on configurable and scalable integrations, which allow for more flexibility and reduces time and cost necessary to respond to federal and state enhancements.

A key strategy of the project is to remove Medicaid-specific requirements in order to allow for easier customization, increased vendor competition, and reduced cost. SCDHHS intends to retain control over policy, business rules, and reference data. SCDHHS retains control over an Operational Data Store (ODS) and all EDI components. 

The major sub-project components of the Replacement MMIS Program are:

˃ Provider Management
˃ Analytics
˃ Accounting and Finance
˃ Commercial Administrative Services Organization (ASO) for FFS Claims

Supporting the projects are:

˃ Technical Integration
˃ Project Management Integration
˃ Business Integration

The Replacement MMIS Business Integration Lead will work with the Project Director and the Lead Project Manager and will support the Project Management team to ensure the commercial principles, business goals and values of the project are met. 
Duties include:
• Perform business process analysis and performance assessments for the assigned projects
• Train and mentor team members in delivering high quality business solutions that meet the overall strategy and vision
• Build positive relationships with clients and proactively address specific needs
• Lead business design sessions within assigned modules and work streams
• Advocate and lead business integration in support of the RMMIS ASO project 
• Provide backup role to the ASO product owner
• Drive, though dynamic discussion, efficient configuration of data within the core modules of RMMIS projects
• Provide liaison role between business and IT verticals
• Ensure project deliverables for each project connect to the operational principles
• Coordinate priorities and resources between multiple projects. 
• Provide updates on status and issues for all assignments 
• Participate in scheduled operational meetings and routine team leads meetings
• Lead cross-functional meetings and produce business designs that integrate functionality across modules
• Facilitate sessions to effectively resolve issues if any. 
• Provide recommendations of appropriate resources if necessary to ensure assignments are completed within given time and budget. 
• Create and maintain key performance indicators to indicate project progress toward commercial integration goals.

• At least ten years of experience in commercial healthcare. 
• At least five years' experience in State Medicaid payer system integration and delivery
• Experience with inner workings of cross functional projects
• Familiarity with Medicaid Information Technology Architecture (MITA) business architecture principles.
• Familiarity with standard MMIS data structures, electronic data interchange, processes and related file formats.
• Knowledge of Federal Certification requirements and processes is preferable.
• Interest, skill and ability to innovate including business processes, methods/procedures, and technology.
• Ability to effectively work and communicate, in both oral and written, with all levels of the Agency from frontline workers to Executive Staff as well as the Contractor(s).
• Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
• Willingness and ability to effectively engage with people and organizations on a continuous basis.

• Large business and technology integration 
• Commercial integrations with Medicaid or other Government operations
• Project management

Bachelor Degree, preferred

PMP Certification, preferred