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MostlyMedicaid Completed a Medicaid Ideas Workshop with 25 Leaders from Government, Health Plan and Solution Providers

Overall summary of event

February 4, 2024

St. Petersburg Marriot, FloridaThe February 2024 Mostly Medicaid Ideas Workshop was a huge success, convening executives from multiple state HHS agencies, Medicaid plans, and solution providers.

Highlights from the Feb. 2024 MostlyMedicaid Ideas Workshop

MostlyMedicaid convened more than 2 dozen HHS leaders from across the country to facilitate a robust discussion on key trends and challenges in our Medicaid space. The workshop used a combination of national trends discussion and group surveys to create a “true public square.”

Kris Vilamaa and Clay Farris of MostlyMedicaid covered key national trends related to the state and federal policy landscape and technology in Medicaid. Surveys of the group touched on several key topics, including: The Medicaid / PHE unwinding in 2024, top state challenges, populations with the most need for support, Medicaid performance on quality measures, and coming state budget challenges.

According to Clay Farris, the discussion from these MM Ideas Workshop is a critical part of improving the Medicaid program: “I think the Ideas Workshop was a clear indication of the need I think the Ideas Workshop was a clear indication of the need to have a true dialogue on many things in our Medicaid industry. The level of engagement in these discussions is extremely high, and its amazing what gets surfaced when smart people are just given the floor to talk. Kris and I provide a limited structure to make sure its helpful, but beyond that the resulting ideas are truly sourced from the execs and thought leaders in the room.”

Following the group discussion, Workshop attendees were treated to a discussion of Medicaid LTSS from one of the most impactful leaders in our space- Carol Steckel. Carol shared insights from her career as a Medicaid director in multiple states, as well as experiences working with PACE programs.

Resolutions from the Workshop included:

1. Build a habit on our teams of envisioning an actual member during our policy and solution discussions within our organizations. Ask – “whats the impact,” and “how will they experience this?”

2. Work to identify un-necessary training or cert requirements that may be hidden burdens on the already-strained workforce.

3. Work to think of the service array / benefits for the same member populations as more consistent (instead of dependent on payer source). While we identified this as a moonshot, it was generally agreed as very important.


About MostlyMedicaid  


Mostly Medicaid reaches thousands of Medicaid industry professionals, decision makers and influencers with its thought leadership publications and information sharing products. We also provide consulting, training and market intelligence services for HHS agencies, Medicaid plans, and solution providers working in the Medicaid industry. MostlyMedicaid offers a unique value in the Medicaid industry by focusing on data-driven business perspectives rather than policy-only or advocacy-only positions.

If you are an HHS agency, a Medicaid health plan, or a solution provider looking to grow your impact in the Medicaid space- We Can Help.


About the MostlyMedicaid Ideas Workshop


The MostlyMedicaid Ideas Workshop is a unique series of gatherings designed to create a “true public square.” The modern Medicaid industry has been over-run with vendors and consultants who are all saying the same things (that just so happen to align with their solutions). But there is a growing number of people in this space who want a space to talk more broadly, and across stakeholder groups. Thats why we created the one-of-a-kind MostlyMedicaid Ideas Workshop. Our unique ability to convene stakeholders from our 10,000-strong audience of Medicaid professionals allows us to fill this gap. The MM Ideas Workshops combine Medicaid SME with a passion for building dialogue. Attendees include C-Suite executives from HHS agencies, Medicaid health plans, and solution provider organizations. Participation is by invite-only and is kept anonymous.

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Job Summary

The Director of Credentialing for the Medical Group possesses primary responsibility for leading and managing operational requirements of the Credentialing Department in support of the medical group as well as the health care system. The Director will effectively lead and serve as the subject matter expert on all credentialing and privilege processes for medical providers and allied health professionals ensuring consistency, accuracy and compliance with established protocols, accrediting and regulatory agencies. The Director of Credentialing coordinates and collaborates with RWJBH business leaders and colleagues on day-to-day operations as it relates to credentialing.

Essential Functions

  • Develops, implements, and maintains credentialing processes and procedures to meet the needs of practices, hospitals, payers, the market, state regulations and NCQA, Medicare/Medicaid, delegated credentialing and any other credentialing parties.
  • Ensures ongoing compliance with state regulatory, legislative, NCQA, Medicare/Medicaid, Joint Commission, payer credentialing, and accrediting body requirements or laws.
  • Directs and coordinates all credentialing activities for department staff, related committees (Credentialing and Appeal Committees), and third party credentialing provider (symplr). Ensures consistent, accurate, and timely execution of credentialing processes and information.
  • Represents the Credentialing Department at medical group, system, and state/regulatory meetings. Partners with business leaders as it relates to operations and credentialing initiatives.
  • Prepares and maintains regular department reporting and credentialing database.
  • Establishes strategic goals in alignment with corporate objectives, setting priorities and managing department performance to meet developed goals.
  • Manages and maintains department budget.
  • Completes managerial duties as it relates to staffing, scheduling, performance reviews, workflows, staff development and training.
  • Other duties or special projects as assigned.

Job Requirements

  • Bachelor’s degree required. Master s degree preferred. Appropriate experience may be substituted for education requirements.
  • Minimum 5 years of credentialing experience to include at least 8 years management or supervisory experience in a credentialing setting required.
  • Professional Medical Services Management Certification (CPMSM) or Professional Credentialing Specialist Certification (CPCS) preferred; or the ability to obtain certification(s) within one year of employment.
  • Knowledge of credentialing software (symplr ) preferred.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey, with a service area covering five million people. The system includes eleven acute care hospitals Clara Maass Medical Center in Belleville, Community Medical Center in Toms River, Jersey City Medical Center in Jersey City, Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood, Newark Beth Israel Medical Center in Newark, RWJUH- New Brunswick, RWJUH- Somerset in Somerville, RWJUH- Hamilton, RWJUH- Rahway and Saint Barnabas Medical Center in Livingston; three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital), a freestanding 100-bed behavioral health center, trauma centers, a satellite emergency department, ambulatory care centers, geriatric centers, the state s largest behavioral health network, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy services, a medical group, multi-site imaging centers and an accountable care organization.

RWJBarnabas Health Medical Group is a multispecialty group practice comprised of highly trained and experienced world class primary and specialty care physicians. RWJBarnabas Health Medical Group physicians provide compassionate and innovative cutting-edge care for people at every stage of life at easily accessible facilities conveniently located throughout New Jersey. Backed by the vast continuum of resources of RWJBarnabas Health, the largest not-for-profit integrated health care delivery system in New Jersey and one of the largest in the nation, our dedicated physicians and expertly trained supporting staff continuously strive for clinical excellence.

We offer a great work environment, competitive rates and excellent benefits, including:

  • Medical/Dental/Vision plans
  • 401 (k)
  • PTO
  • Short & Long Term Disability
  • Basic Life & Accidental Death Insurance
  • Tuition Reimbursement
  • Health Care/Dependent Care Flexible Spending Accounts
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Senior Sales Executive Government Medicaid Payment Integrity Payment Accuracy, Frankfort, Kentucky


Senior Sales Executive Government Medicaid Payment Integrity Payment Accuracy

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.

Senior Sales Executive Payment Integrity – Payment Accuracy – State Medicaid

The Solution Sales Executive (State Medicaid focus) is responsible for acting as the sales lead in closing new opportunities in the State Medicaid Agency by demonstrating the unique value proposition of CHC Payment Accuracy Solutions.

What will be my duties and responsibilities in this job? Identifying opportunities to sell CHCs Payment Accuracy solutions into net new and existing customers

  • Directing and conducting sales presentations with Solution Consultants and/or Client Executives
  • Collaborating with Account Managers and SSEs to coordinate efforts in identifying leads
  • Maintaining thorough understanding of the State Medicaid Agency market nationally with emphasis on delivery of CHC Payment Accuracy solutions.
  • Orchestrate and lead detailed pre-sales planning and strategy, post sales handoff to implementation and ongoing knowledge transfer to Client Executives
  • Negotiate and close contracts and coordinate with CHC legal and product as needed.
  • Professional and effective communication skills required including comfort with conversations that create clarity and improve collaboration at all levels within complex and diverse organizations
  • Effective analytical, problem-solving, and decision-making skills

    What are the requirements needed for this position?

  • Education/Training BA/BS, MBA preferred.
  • Minimum of 5 -10 years Sales experience selling Payer Payment software/Payment services directly to Goverment State Medicaid Agencies and/or through Fiscal Intermediaries and/or BPO/Business Processing Outsourcing Firms.
  • Experience developing a footprint across the U.S and upselling, nurturing business relationships, retaining and expanding our clients footprint.
  • Demonstrated track record & proven quota performance selling to the State Medicaid market
  • Keeping all opportunities current within Salesforce and providing updates to CHC Management
  • Experience with Excel, CRM tools, and Net Promoter Score preferred

    What other skills/experience would be helpful to have?

  • We will also consider candidates that have experience selling healthcare payer services
  • Extensive knowledge of Payment Accuracy/Payment Integrity/Cost Containment/Fraud Waste Abuse, Special Investigation Unit/SIU solutions in the healthcare and payer marketplace
  • Experience selling healthcare software solutions and services directly to State Medicaid Agency
  • Proficient at executing when experiencing multiple competing priorities
  • Strong interpersonal and communication skills
  • The ability to build relationships across the organization, especially at the Payer C-Level and collaborate as necessary to accomplish goals
  • Maintain State Medicaid industry, product specific knowledge and competitor differentiation
  • Strong organizational and time management skills
  • Successful track record of working as a part of dynamic, fast-paced and growing teams that are results oriented and collaborative.
  • Effective analytical, problem-solving and decision-making skills.

    What are the working conditions and physical requirements of this job?

  • General office demands

    How much should I expect to travel?

  • Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.
  • Willingness and ability to travel 70% of the time depending on COVID travel restrictions / Current State: We are visiting some clients and not travel 70%.
  • Territory: National
  • You can be based out of within 1 hour of major airport

li-remote Diversity and Inclusion:

At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at Feeling Inspired? Ready to ? Apply today!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when j ob-related and consistent with business necessity , we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at and the supplemental information at

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to with “Applicant requesting reasonable accommodation” as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcares Privacy Notice to California Job Applicants Regarding the Collection of Personal Information () .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.


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Mostly Medicaid Announces Medicaid Solution Provider Innovations Awards Submissions

MM Curator summary

[MM Curator Summary]: We are highlighting innovative solution providers in the Medicaid space- nominate someone today!


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.




BIRMINGHAM, ALABAMA, UNITED STATES, June 1, 2022 / — MostlyMedicaid, the leading provider of Medicaid solution provider news, trends, insights and best practices announced the 2022 Medicaid Solution Provider Innovations project today.

Medicaid solution providers are a key part of the innovative programs delivered by states and managed care plans. These vendor partner companies provide solutions for things like data analysis, care management, transportation, and a whole range of other critical Medicaid business operations.

While some solution providers are well-known in our space, there are many that are not – and they are doing great work that can be leveraged in more Medicaid programs.

If you want to highlight the great work of a solution provider in the Medicaid space please fill out our simple survey here-

The survey is open for submissions as of June 1st, 2022. You can nominate a Medicaid vendor partner through October 20th, 2022. Early submissions are encouraged.

About Mostly Medicaid

Mostly Medicaid reaches thousands of Medicaid industry professionals, decision makers and influencers with its thought leadership publications and information sharing products. We also provide marketing and strategy consulting services for companies in the Medicaid industry, as well as premium educational content to enhance expertise for industry professionals. Mostly Medicaid offers a unique value in the Medicaid industry by focusing on data-driven business perspectives rather than policy-only or advocacy-only positions.

We began with one simple concept in mind – think of Medicaid as a massive industry. Besides the healthcare services provided to Medicaid enrollees, there are hundreds of thousands of people that process claims, build software, consult with hospitals – just to name a few segments. Those people need services and products to help them do their jobs, increase their revenues and improve their skills.

And that’s where Mostly Medicaid comes in. We are uniquely positioned to reach influencers across all segments and provide them with actionable information and recommendations. We have built a brand with 10,000 Medicaid industry professionals who trust us to bring non-biased information to them.

For inquiries about this announcement:
For Mostly Medicaid
Clay Farris
Mostly Medicaid
+1 919-727-9231
email us here

Clay Farris
Mostly Medicaid
+ +1 9197279231

email us here


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3 tips for Medicaid Health Plans on Inviting Solution Vendors to Your Next RFP

Many of our clients are health plan professionals working in the health and human services space (including Medicaid plans and Medicare Advantage plans). The article below is based on our experience working with health plan staff who have succeeded in improving vendor management and procurement activities.

Reading Time: 3 minutes

Intended Readers: Medicaid Health Plan vendor management teams and executives

Tip 1: Invite more than you need

Its always good to have options. You should try to have at least two very strong candidates make it past the initial evaluation period. And in order to do that, you probably need at least 4 bidders to submit a proposal. And in order to have that many proposals, you probably need to invite 5 or 6 bid. Invite specific vendors you have initially vetted (versus a broad open call) when possible. This will mean more work on the front end of your procurement effort, but will lead to stronger proposals and more interested vendors.

Tip 2: Rely on references from your health plan peers

Your number one asset in this process is other health plans who have done business with the bidders. In the Medicaid space, most plan staff are less concerned about competition (except during MCO contract award cycles) and are more concerned about improving the delivery of services in the Medicaid program. Don’t be shy about asking your contacts in other plans for their opinion on vendors.

  Tip 3: Hold a 1 on 1 pre-invitation discussion with each vendor

Remember your goal is high quality proposals. In order to provide those, vendors need to understand as much as they can about your goals for the project. In addition to the normal group Q&A call offered to vendors, consider offering 1 on 1 discussions to make sure vendors are aligned with your vision for the project. The number of vendors interested will dictate how much time you invest in this step. Its also recommended to conduct this part of the process with another trusted external consultant if possible. This step will minimize confusion over goals and scope before proposals are submitted, without adding even more workload to your operational staff.

How to get started implementing these tips

We assist clients with each of these strategies, and are happy to have a conversation anytime. If our services and expertise are a fit for your needs as you develop or execute your strategy, engaging with us is a simple process. If we are not the right fit, we are happy to make a referral to another firm who may be.

Knowing what to do is only the first step. Knowing how to implement these tips with your current team amid many other priorities is more complex.  Here are a few other pointers on improving your options for your next vendor procurement:

  1. Create a short list of invitees and gauge interest with them before executing your full procurement effort– List the three vendors that immediately come to mind, and have a half hour exploratory discussion with a small group from their team. This can help you rapidly identify any key changes or clarification needed to your requested project scope without the extensive resource cost of an RFI.  
  2. Assign an existing team member to own the procurement effort from a project management perspective OR hire an external consultant to focus on the effort- If your project is not too large, or not too complex, you can assign a team member to drive key work items that are often overlooked like scheduling and action item management.  

MostlyMedicaid: We can help.