Sr. Project Manager ( Medicaid)

Contract Term: 18 months

Location: Sacramento,CA

Project Overview: The Contractor will provide advisory and analytical support regarding the alignment of HIPAA transaction data to standard information architecture to facilitate semantic interoperability within the Medi-Cal enterprise, and with organizations and systems utilizing standards recognized by the Centers for Medicare & Medicaid Services (CMS). The Contractor will also provide an updated Medicaid Information Technology Architecture (MITA) self-assessment document; and will include the State MITA roadmap relative to achieving HIPAA compliance for each impacted program area. The MITA services will help DHCS significantly by documenting the current capabilities of Medi-Cal business processes against an established and standardized framework. The services will also allow DHCS to determine how to leverage IT resources and make IT investments over the next five-to-ten years to help the program evolve.

Services to be Performed: The Contractor will provide HIPAA transaction expertise to the OHC IT Section Chief. The Contractor will work with department and other staff to analyze, plan and create the process to facilitate DHCS compliance on the new HIPAA and MITA transition. The Contractor will develop a solutions alternatives matrix. The Contractor will be responsible for updating the MITA SS-A with all components as described by CMS.

The MITA Information Architecture includes three components (conceptual data model (CDM), logical data model (LDM) and data standards. The Contractor will participate in the CDM and LDM efforts. The Contractor will be required to produce and roll out the following work products:

1) Data Standards Management Plan

2) Enterprise Data Standards

3) Conceptual Data Model

4) Logical Data Model

5) MITA Business Process Re-engineering document

The Data Standards Management Plan will include a schedule, methodology, and strategy for development and rollout of the Enterprise Data Standards. The Enterprise Data standards will bring to DHCS industry standard terminology (ASC X12, HL7, NCPDP, etc.). The Contractor will be responsible for creating a data dictionary for DHCS. The Contractor will also be responsible for updating all DHCS documentation with the new terminology. The Contractor will conduct education sessions, Intranet content and documentation to ensure DHCS staff are knowledgeable in the new data standards.

Data standards fall into two major categories – structure data standards and vocabulary data standards:

1) Structure data standards – Specify how to format or structure data.

2) Vocabulary data standards – Deal with the content of the data elements. Vocabulary data standards enable systems to understand the meaning of the data.

The Contractor will work with the DHCS Enterprise Architect Office (EAO) to produce an enterprise conceptual data model and an enterprise logical data model. The Contractor will use data modeling tools agreed upon by DHCS.

The Contractor will lead the effort to re-engineer current business processes to match MITA business processes. These changes will include:

1) Recommending organizational changes

2) Collapsing or integrating business processes

3) Documenting the changes in a MITA business model document

A minimum of three (3) years’ experience interpreting and applying HIPAA Transactions requirements.  

  Three (3) years’ experience with medical systems that have a Medicaid component.

The Contractor should have Subject matter expertise on HIPAA transactions.

Specific experience in a key role participating in HIPAA Transactions, Code Sets, or National Provider Identifier (NPI) projects (one (1) or more projects in one (1) or more organizations).

Membership and participation in national HIPAA standards settings organizations, workgroups, and other HIPAA-related organizations.

Additional experience working in the health care information technology industry (e.g., project manager, business/technical analyst, developer, health informaticist, clinician, etc.).

Experience working with requirements related to the Medicaid Information Technology Architecture (MITA) initiative.

Experience reflecting the ability to communicate effectively in a multi-disciplinary environment (i.e., business and technical staff, management, clinicians, etc.)