ForHealth Consulting at UMass Chan Medical School · 1 day ago
Medicaid Eligibility Consultant III
Westborough, MA
Full-time
Hybrid
Senior Level
5+ years expForHealth Consulting at UMass Chan Medical School is seeking a Medicaid Eligibility Consultant III to assist in developing and implementing revenue initiatives for Medicaid programs. The role requires strategic leadership in Medicaid eligibility systems, project management, and stakeholder engagement to ensure compliance with Medicaid regulations and enhance program integrity.
Management Consulting
Responsibilities
Provide strategic oversight and lead the development, management, coordination and implementation of Medicaid eligibility and program integrity initiatives, in and out of state
Serve as project lead in the analysis and evaluation of data to support Medicaid eligibility and program integrity cost savings projects in and out of state
Lead in the research & development of new business opportunities
Direct and manage assigned projects from start to finish
Develop comprehensive work plans, define resource needs, and allocate tasks to support efficient project execution
Provide strategic leadership in the development of Medicaid systems on behalf of the client Medicaid agency:
Serve as Lead Subject Matter Expert (SME) in Medicaid eligibility regulations, operations, and processes to support the design, development, and implementation of changes to Medicaid MAGI and non-MAGI eligibility systems
Assist with and present Medicaid agency business needs and strategic vision in systems development activities and ensure they align with agency objectives
Actively participate in discussions in multi-agency workgroups supporting the development of a common eligibility application
Participate in meetings with the systems upstream and downstream stakeholders to assess needs and provide solutions
Engage stakeholders to assess complex system needs and design integrated solutions that align with policy and operational goals
Attend business and system design sessions
Review, provide feedback and approve appropriate business system design requirements
Attend regularly scheduled and ad hoc meetings virtually and onsite; and
Assist with testing and resolution of system defects
Lead the development of agreements between public entities and the University
Assist in the evaluation and respond to grant and business proposals by providing reporting and data analysis
Develop and present success, merits of initiative to staff and clients
Research and develops work plans to implement projects
Coordinate with subcontractors to obtain data for various initiatives
Qualification
Required
Master's Level Degree or equivalent in a business health policy, social service, or public administration related field
5-7 years experience in a related field
Extensive experience in interpreting State and Federal regulations as they apply to public assistance programs
Extensive and in-depth knowledge of Medicaid policies, programs and procedures and the ability to integrate this knowledge with new and existing IT systems
Experience working with complex technical, systems and/or programs issues affecting Medicaid and its services to members
Excellent verbal and written communication skills
Project management skills and experience in implementing and project management of large projects
Demonstrated ability to work numerous projects simultaneously and meet deadlines
Experience in supervision and/or demonstrate ability to manage and motivate staff
Expertise in Microsoft Word, Excel and PowerPoint and Access or SQL
Ability to travel to the client and/or off-site locations weekly
Preferred
Strong quantitative and analytical skills
Ability to facilitate meetings and establish working relationships with various government and private contractors
Exceptional oral and written communication skills
Exceptional organizational skills
Team leadership skills
Company
ForHealth Consulting at UMass Chan Medical School
ForHealth Consulting partners with purposeful organizations, including state Medicaid agencies and health and human services organizations, to make the healthcare experience better for all – more equitable, effective, and accessible.
501-1000 employees
H1B Sponsorship
ForHealth Consulting at UMass Chan Medical School has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (98)
2024 (104)
2023 (106)
2022 (116)
2021 (2)
Funding
Current Stage
Late StageLeadership Team
Carly Gould
Senior Human Resources Business Partner
Jatin Dave
Chief Medical Officer, MassHealth
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