Ensures that the contractual, regulatory, and accreditation requirements and objectives of HMSA’s Medicaid Programs are identified and met. Responsible for assisting with and supporting the development, implementation, planning, and oversight of activities related to Medicaid program requirements and objectives as assigned under the direction of the Director, Medicaid Administration and Sr. Manager, Government Programs.
Responsible for assisting with communication and coordination with HMSA departments, subsidiaries, and business associates that support Medicaid Program requirements and objectives and also for participating in the evaluation of their performance. Also responsible for assisting with the management of projects related to enhancing existing capabilities or developing new capabilities for the Medicaid line of business and analysis of business information with emphasis on the identification, development, and use of appropriate data and analytical methods for answering specific business questions related to HMSA’s Medicaid Programs.
- Bachelor’s (BA) degree and four (4) years of related work experience; or an equivalent combination of education and related work experience.
- Effective verbal and written communication skills
- Demonstrated knowledge of the operation of managed care programs.
- Demonstrated knowledge of Hawaii’s QUEST program or other governmental managed care programs.
- Intermediate knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
Duties and Responsibilities
Business Solution Development:
- Develop, maintain and coordinate department user requirements, data reporting and application requirements for projects that affect Medicaid Programs.
- Assist with solution design and development.
- Participate in and lead teams involved in projects that affect Medicaid programs and collaborate with project leads and team members from other departments.
- Communicate and collaborate with appropriate staff to ensure suitability of solutions. Develop effective use of advanced analytical methods and tools to enhance the delivery of solutions to meet business requirements. As required, learn new business concepts and methods applicable to Medicaid Programs projects and initiatives.
Business Project Analysis:
- Develop and apply appropriate analytical methods to assigned business projects and tasks.
- Thoroughly document all aspects of project requirements, methodology, task schedule, and analytical results including interpretation of results, summary findings, and presentation reports.
- Collaborate with staff and management in own and other departments as required to fully understand business scope, business constraints, and business implications of analytical results
Program Management:In support of and with assistance from the Director and Sr. Manager, assist with:
- Developing and communicating overall project strategy to ensure that business requirements are fulfilled across all Medicaid Programs activities and projects.
- Ensuring that all Medicaid Program required reports, data, and activities are completed and delivered accurately and on time. Managing all aspects of the planning, execution, and closure of such projects.
- Evaluating and directing the development of best practices, project standards, procedures, and quality objectives utilizing established project standards, procedures, and quality objectives.
- Conducting project kickoff meetings and communicating individual roles and project/program expectations and responsibilities to ensure that all project team members have the tools and training to perform effectively.
- Providing leadership to project managers, project and business leads, and other staff who are assigned to work on Medicaid Programs activities and projects.
- Developing and maintaining collaborative relationships with Project Stakeholders, Business Relationship Managers, Project Office Managers, and other management and staff as necessary to provide oversight on Medicaid Programs activities and projects.
- Identifying and analyzing business needs.
- Translating business needs into appropriate and effective solutions.
- Monitoring the design and implementation of solutions.
- Establishing project baselines and developing project schedules.
- Monitoring project milestones, timelines, technical deliverables, resource usage, critical dates, scope, costs, and quality to identify potential risks.
- Identifying and tracking project issues and resolutions.
- Facilitating the resolution of schedule and project related issues.
- Assessing variance from project plans and implement measures to ensure projects remain within scope, time, cost, and quality objectives.
- Tracking and reporting project status.
- Preparing and presenting project updates to senior management and Executive Steering Committees.
- Preparing and presenting business justification for tactical business priorities as required.
- Facilitating the evaluation, selection, and contract negotiations for external vendors.
- Managing vendor relationships in support of project goals.
- Acting as a liaison between Medicaid Programs department, other HMSA Departments, subcontractors, and vendors.
- Continuously providing constructive team feedback as is pertinent to Medicaid Programs projects.
- Integrating, wherever possible, areas of improvement into the project lifecycle.
- Coaching and mentoring less experienced department personnel.
- Maintaining content of project websites to facilitate effective communication.
Studies and Reports:
- Produce concise, structured, and informative data analytic reports summarizing projects, objectives, methods findings of program significance.
- Document issues, background, data, methods, problems and alternatives, and results.
- Perform all other miscellaneous responsibilities and duties as assigned or directed.
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