Remote Senior Medicaid Policy & Data Expert

UnitedHealth Group; Schaumburg (IL); Remote; USD 113,000 - 193,000; Full time

Job summary

UnitedHealth Group seeks a Senior Medicaid SME to anchor the IL EDW, Medicaid policy interpretation, and CMS-64 reporting. You will translate complex policy into clear business rules, guide cross-functional teams, and briefing senior leadership on how data supports program goals.

You will work remotely from anywhere in the U.S., with occasional in-person collaboration as needed and travel to IL a few times yearly. You will mentor staff and help sustain data governance and reporting integrity.

Qualifications

• 15+ years of healthcare experience, including direct Medicaid agency/EDW exposure.
• 3+ years of experience with CMS reporting like MARS, T-MSIS, PERM, Core Set.
• Hands-on CMS-64 reporting experience including expenditure reporting and FMAP.
• Solid knowledge of Medicaid/CHIP policy and rules.
• Deep understanding of Medicaid data flows from source systems to EDW and reports.
• Ability to present to senior executives with clear briefings.
• Translate policy into business rules for technical teams.
• Proficient in SQL or similar tools for data validation.
• Willingness to travel to Springfield, IL several times a year.
• Excellent written and verbal communication.

Responsibilities

• Serve as senior Medicaid SME for IL EDW and CMS reporting.
• Lead CMS-64 and related federal reporting efforts.
• Support additional federal reporting work (MARS, T-MSIS, PERM, CMS Core Set).
• Interpret CMS/state policy into actionable business rules and requirements.
• Explain data trends and drivers to State leadership in plain terms.
• 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 from a business perspective.
• Identify data quality risks and propose practical fixes.
• Mentor analysts and ensure knowledge continuity.

Skills

Healthcare experience

Medicaid data

CMS reporting

CMS-64 reporting

Medicaid policy

Medicaid data flow

Executive briefing

Policy translation

SQL queries

Travel flexibility

Communication skills

Medicaid finance ops

CMS certification

Product owner SME

Illinois Medicaid

BI tools (Tableau/Power BI)

Project tools (Azure DevOps/JIRA)

CMS reporting systems

Location IL commuting

Tools

SQL

Job description

UnitedHealth Group seeks a Senior Medicaid SME to anchor the IL EDW, Medicaid policy interpretation, and CMS-64 reporting. You will translate complex policy into clear business rules, guide cross-functional teams, and briefing senior leadership on how data supports program goals.

You will work remotely from anywhere in the U.S., with occasional in-person collaboration as needed and travel to IL a few times yearly. You will mentor staff and help sustain data governance and reporting integrity.