Remote Medicaid Policy & EDW SME – CMS-64 Expert

Myticas Consulting Inc.; Springfield (IL); Remote; USD 83,000 - 99,000; Full time

Job summary

Clover Consulting is seeking a senior EDW Medicaid SME (Federal Reporting & Policy) for a 12+ month contract. Remote with occasional travel to Illinois. Focus on CMS-64 and related federal reporting within Medicaid data and policy domains.

The role requires deep knowledge of Medicaid policy, data flows, and executive communication to Agency leadership. 15+ years in healthcare and Medicaid data environments preferred.

Qualifications

• Experience with CMS-64 and federal reporting requirements.
• Strong ability to translate policy into business rules for technical teams.
• Excellent communication and executive briefing skills.
• Ability to travel to Springfield, IL 3–4 times per year.

Responsibilities

• Serve as senior Medicaid business and policy SME for IL EDW and CMS reporting.
• Lead CMS-64 reporting support including FMAP, reporting periods, and reimbursements.
• Support CMS reporting work such as MARS, T-MSIS, PERM, Core Set measures.
• Translate CMS guidance into clear business rules for technical teams.
• Explain data trends and policy drivers to leadership with concise briefings.
• Deliver executive briefings and recommendations to Optum and State leadership.
• Collaborate with State finance, MCOs, and vendors on reporting timelines.
• Review report logic and data mappings for business validity.
• Identify data quality risks and propose practical fixes.

Skills

SQL

Tools

Teradata

Business Objects

Tableau

Power BI

Azure DevOps

JIRA

SharePoint

Job description

Clover Consulting is seeking a senior EDW Medicaid SME (Federal Reporting & Policy) for a 12+ month contract. Remote with occasional travel to Illinois. Focus on CMS-64 and related federal reporting within Medicaid data and policy domains.

The role requires deep knowledge of Medicaid policy, data flows, and executive communication to Agency leadership. 15+ years in healthcare and Medicaid data environments preferred.