Medicaid Program Manager Jobs in Reston, VA (NOW HIRING)

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Job Description
I. DESCRIPTION OF SERVICES
Texas Health and Human Services Commission requires the services of 1 Project Manager 2, hereafter referred to as Candidate(s), who meets the general qualifications of Project Manager 2, Project Management and the specifications outlined in this document for the Texas Health and Human Services Commission.
Level Description
3- 7 years of experience in the field or in a related area. Familiar with standard concepts, practices, and procedures within a particular field. Relies on limited experience and judgment to plan and accomplish goals. A certain degree of creativity and latitude is required. Works under limited supervision with considerable latitude for the use of initiative and independent judgment. Minimum of three (3) years of progressive broad-based information systems, system integration and project delivery experience. Experience working with external vendors and/or Quality Assurance efforts a plus.
Job Description
Project managers are the people in charge of a specific project or projects within a company. As the project manager, your job is to plan, budget, oversee and document all aspects of the specific project you are working on. Project managers might work by themselves or be in charge of a team to get the job done. Project Management Professional (PMP) certification is required and should be noted on the resume. Proof of certification may be requested.
Additional job details and special considerations
The Provider Services unit (formerly Operations Management Claims Administration) supports Medicaid and CHIP Services (MCS) providers with Fee-for-Service (FFS) claims management, support, and administrative appeals for both long-term care, and acute care; provider enrollment; and Electronic Visit Verification (EVV).
A Project Manager (PM) is needed to manage the Provider Enrollment and Management System (PEMS) Plus Credentialing project. PEMS is HHSC's system for enrolling providers into the Medicaid program. Providers must be enrolled to deliver services to Medicaid clients and receive payment from HHSC or the Medicaid Managed Care Organizations (MCO) and/or the Dental Maintenance Organizations (DMO). In addition to Medicaid enrollment, providers must also be credentialed by the MCOs and DMOs that they contract with. The credentialing process ensures providers have appropriate qualifications to provide the services they are contracting for. For example, a physician's license would be verified through the credentialing process. This project will ensure the credentialing process is fully integrated into the PEMS application to streamline provider enrollment and reduce the number of steps providers must take to get enrolled and credentialed.
The worker will serve as a Project Manager for the PEMS Plus Credentialing project and support activities as needed. The worker will manage and lead the project of integrating the credentialing application used by MCOs/DMOs into PEMS. The worker will report to governance committees on the activities of the project. The worker will identify, record, and ensure trading partners are aware of critical path dependencies, integration points and oversee testing plans. The worker will work closely with the Director of Provider Services, and the Deputy Associate Commissioner for MCS Operations Management. This Project Manager will oversee and lead the work of other project staff to ensure tasks are assigned, tracked and completed timely and accurately.
The worker will be responsible for delivering quality products that meet the state's desired operational and technical requirements. The worker will have considerable latitude to use their experience and judgement to ensure successful completion of their assigned tasks. The worker will be required to multi-task, analyze priorities, communicate clearly, and set expectations for the phases of the project. The worker will be responsible for communicating with multiple internal and external stakeholders including program and technical staff, and other contracted and vendor resources. The worker will participate in meetings, track deliverables and schedules, and alert management of any issues that may impact providers.
The services to be provided include, but are not limited to the following:
- Coordinating duties and responsibilities with PEMS Sprint Teams and Provider Services.
- Development, maintenance, and monitoring of integrated project timelines in coordination with PEMS project timelines.
- Ensuring that the project plan maintains tasks, schedules, and status updates as well as disseminating information to team members.
- Oversight and reporting of critical path dependencies between PEMS projects.
- Communicating project status, issues, and risks to department management, HHSC vendors, Provider Services and PEMS sprint teams. Developing mitigation plans as necessary.
- Communicating status of program initiatives to department management and other impacted stakeholders.
- Planning and managing efficient project meetings and documenting key decisions.
- Designing strategies to mitigate or avoid identified project risks and difficulties.
Required certification in Project Management by a recognized project management organization. Scrum Master a plus.
Resumes will not be accepted from applicants outside of Texas. The worker will be required to travel as needed to the primary work location in the Austin office. Remote work may be considered in accordance with HHSC Telework Policies, which includes in-office attendance.
II. CANDIDATE SKILLS AND QUALIFICATIONS
| Minimum Requirements:
Candidates that do not meet or exceed the minimum stated requirements (skills/experience) will be displayed to customers but may not be chosen for this opportunity.
| Years | Required/Preferred | Experience
| 7 | Required | Experience in management of large-scale IT projects, including system integration, resource management, procurement transition and vendor management.
| 7 | Required | Experience with Medicaid Enterprise Systems, including Medicaid Management Information Systems (MMIS).
| 7 | Required | Ability to identify problems, evaluate alternatives, and implement effective solutions; to develop and evaluate policies and procedures; to prepare reports.
| 7 | Required | Demonstrated ability to meet tight deadlines.
| 7 | Required | Experience with Medicaid business operations.
| 7 | Required | Experience overseeing the planning and execution of major projects, including facilitation and documentation of high-level critical path dependencies across multiple projects.
| 7 | Required | Experience successfully leading meetings and facilitating discussions between multiple stakeholder groups, including vendors.
| 7 | Required | Expertise using Microsoft Office products: Teams, Word, Excel, PowerPoint, Project, Outlook.
| 7 | Required | Ability to establish project goals and objectives that support the state and HHS strategic plans as well as federal directives.
| 7 | Required | Proven ability to work successfully with technical and non-technical groups and manage multiple responsibilities.
| 7 | Required | Excellent analytical, problem-solving, and coordination skills.
| 7 | Required | Experience and judgment to plan and accomplish goals and independently perform a variety of complicated tasks; a wide degree of creativity and latitude is expected.
| 7 | Required | Oral and written communication skills.
| 4 | Required | Required certification in Project Management by a recognized project management organization.
| 3 | Preferred | Knowledge of Texas Medicaid programs.
| 2 | Preferred | Experience with Texas Health and Human Services programs.
| 2 | Preferred | Experience with provider enrollment systems.
| 1 | Preferred | Scrum Master certification preferred.
III. TERMS OF SERVICE
Services are expected to start 10/13/2025 and are expected to complete by 02/27/2026. Total estimated hours per Candidate shall not exceed 792 hours. This service may be amended, renewed, and/or extended providing both parties agree to do so in writing.
IV. WORK HOURS AND LOCATION
Services shall be provided during normal business hours unless otherwise coordinated through the Texas Health and Human Services Commission. Normal business hours are Monday through Friday from 8:00 AM to 5:00 PM, excluding State holidays when the agency is closed.
The primary work location(s) will be at 701 W. 51st Street, Austin, TX 78751. The working position is On Site. Any and all travel, per diem, parking, and/or living expenses shall be at the Candidate's and/or Vendor's expense. Texas Health and Human Services Commission will provide pre-approved, written authorization for travel for any services to be performed away from the primary work location(s). Pre-approved travel expenses are limited to the rates and comply with the rules prescribed by the State of Texas for travel by its classified employees, including any requirement for original receipts.
The Candidate(s) may be required to work outside the normal business hours on weekends, evenings and holidays, as requested. Payment for work over 40 hours will be at the hourly rate quoted and must be coordinated and pre-approved through Texas Health and Human Services Commission.
If you are interested, so please sent me your resume on this email sara@ahutechnologies.com
Compensation: $55.00 - $58.00 per hour
About Us
AHU Technologies INCis an IT consulting and permanent staffing firm that meets and exceeds the evolving IT service needs of leading corporations within the United States. We have been providing IT solutions to customers from different industry sectors, helping them control costs and release internal resources to focus on strategic issues.
AHU Technologies INC was co-founded by visionary young techno-commercial entrepreneurs who remain as our principal consultants. Maintaining working relationships with a cadre of other highly skilled independent consultants, we have a growing number of resources available for development projects. We are currently working on Various projects such as media entertainment, ERP Solutions, data warehousing, Web Applications, Telecommunications and medical to our clients all over the world.