Hybrid Medicaid Subject Matter Expert na Briljent, LLC

Description

We are seeking a Medicaid Subject Matter Expert (SME) to provide strategic guidance and expertise in Medicaid policy and operations. This role will support a large-scale Medicaid modernization effort, ensuring business process workflows and architecture artifacts align with MITA and CMS compliance standards. The ideal candidate will have extensive experience in Medicaid operations, children's medical services, and policy development.

Key Responsibilities:

• Serve as a Medicaid SME for the project team and external stakeholders.
• Provide strategic guidance on Medicaid processes, regulations, and operational improvements.
• Research and document Medicaid-specific policies, workflows, and business processes.
• Facilitate business architecture workshops and ensure Medicaid-related context models and process maps are aligned with best practices.
• Collaborate with technical and business teams to ensure Medicaid compliance within modernization initiatives.
• Provide recommendations for process improvements based on Medicaid operations and best practices.
• Support documentation of business processes and workflows for future-state planning.
• Act as a bridge between Medicaid business units, IT teams, and external agencies.

Requirements

• 10+ years of experience in large-scale healthcare solutions.
• 4+ years of experience in enterprise systems or IT projects.
• Bachelor’s degree in a relevant field.
• Extensive experience in Medicaid operations, policies, and system modernization.
• Proficiency in MITA framework and CMS compliance.
• Proven track record in facilitating Medicaid-focused business architecture workshops.
• Strong ability to analyze and document Medicaid-related business processes.
• Excellent stakeholder management and communication skills.

Preferred Qualifications:

• Experience with New York state Medicaid systems or similar state-level Medicaid programs.
• Master’s degree preferred.
• 2+ years of experience in a large healthcare system.
• Certifications in Lean Six Sigma, Agile, Medicaid operations, IT Governance, or Risk Management.

Physical Requirements & Environmental Conditions: An employee must meet these physical demands to successfully perform the essential functions of this job. Employee is regularly required to talk or hear, sit, and utilize technology tools such as a laptop computer for extended periods of time. Specific vision abilities include close vision and the ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Briljent is a solutions-based company.  Solutions come from creative ideas; ideas come from being creative with differences.  Briljent believes diversity and inclusion are critical to the success of the company.  Employment at Briljent is based on merit and professional qualifications.  We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.