Medicaid Program Integrity Jobs in Raleigh, NC (NOW HIRING)

For more details, please connect with Priyam Nagwani at 303-990-5305 or email at priyamn@vgroupinc.com

End Client: State of North Carolina

Job Title: DHB Certification & Compliance Project Specialist

Duration: 10 Months

Start Date: ASAP

Position Type: Contract

Number of Hours: 40 Hours a Week

Location: Remote

Interview Type: Webcam

Position ID: 809686

Description: This position is essential to supporting federal compliance efforts, including AoA, the MES Certification schedule, PBA CRR, and DAP, with MITA activities becoming an increasingly important requirement. This position is responsible for supporting and driving the execution of the NC Medicaid Enterprise Systems certification strategy for each project. The Specialist supports ongoing compliance activities including updating the Analysis of Alternatives document, the MES Certification schedule, and the certification readiness assessment which are essential to achieving certification and enhanced federal funding. As CMS introduces evolving and increasingly complex MITA requirements, this role becomes critical to ensure the program remains aligned with new federal standards. The Specialist provides direct support to the Certification Workstream across multiple high visibility MES projects. The role partners closely with Business Leads, Project Teams, matrix managers, vendors, and other key stakeholders to ensure all CMS criteria are met and that certification activities are coordinated, on schedule, and strategically aligned to achieve successful MMIS/CMS Certification. This position is central to protecting program integrity, sustaining federal funding streams, and strengthening statewide Medicaid systems. The Certification and Compliance Project Specialist ensures that certification tasks are executed with precision, compliance risks are minimized, and MES initiatives consistently meet CMS standards. This role collaborates with internal and external stakeholders to support the overall success of the Medicaid Enterprise System (MES) Program.

Responsibilities:

• Responsible for supporting project teams through certification tasks
• Assists with leading certification workstream meetings
• Updates document repository for CMS certification artifacts per project
• Co-manages the Certification Evidence Tracker
• Pulling, recommending, and managing evidence from the implemented solution to meet CMS Certification requirements
• Composing narratives to accompany ORR and CRR evidence
• Oversees system demonstrations for the Business and CMS, as required, to achieve CMS Certification
• Maintains awareness of CMS certification program and policy updates, organization communication as applicable
• Provides project schedule activities to project team for CMS effort aligned with scope of contract for a specific project (for integration into project schedules)
• Adequate preparation for upcoming PBA CRR, DAP, and PDM ORR prep cycles
• Continuity and quality in managing certification deliverables
• Timely coordination with MITRE and project teams
• Utilization of industry best practices for compliance with CMS and State-defined performance standards

Required Skills:

• Healthcare related knowledge, ideally in analytics, reporting or related required 3 years.
• Demonstrated experience using project tracking tools (Microsoft Project, (e.g. Jira, MITAPulse) required 3 years.
• Project management experience including experience managing staff in a matrix or direct reporting relationship required 5 years.
• Experience managing multiple priorities/projects including project scope, schedules, quality, change management and project financials required 5 years.
• Ability to drive, collaborate and coordinate with MITRE and CMS teams required 2 years.
• CMS Medicaid Enterprise Certification Life Cycle process experience required 2 years.
• Experience implementing information systems in client facing role required 5 years.
• Experience in healthcare related knowledge, ideally in analytics, reporting or related required 3 years.
• Experience with preparation for ORR prep cycles required 2 years.
• Experience pulling, recommending, and managing evidence from the implemented solution to meet CMS Certification requirements required 2 years.
• Demonstrated experience using project tracking tools (Microsoft Project, (e.g. Jira, MITAPulse) required 5 years.
• Exceptional technical writing experience, including authoring playbooks, manuals, etc required 5 years.