Senior Medicaid Policy & Data SME (Remote)

Optum; Schaumburg (IL); Hybrid; USD 113,000 - 193,000; Full time

Job summary

Optum Insight is seeking a Senior Medicaid SME to anchor Medicaid data and CMS reporting within the IL EDW, translating policy into actionable business rules and ensuring data integrity.

Remote work is available nationwide with in-office requirements in Minneapolis or DC area four days per week. You will lead executive briefings, collaborate with state finance teams, and mentor analysts on Medicaid data flows and federal reporting requirements.

Qualifications

• 15+ years in healthcare with Medicaid agency or related data programs.
• 3+ years with CMS reporting (MARS, T-MSIS, PERM, Core Set).
• Hands-on CMS-64 reporting experience including FMAP and reconciliations.
• Strong knowledge of Medicaid/CHIP policy, eligibility, waivers, and data flow.
• Proven ability to brief senior executives and translate policy into requirements.
• Proficient in SQL or similar tools.

Responsibilities

• Serve as senior Medicaid SME for the IL EDW and CMS reporting.
• Lead CMS-64 reporting support including expenditures and FMAP.
• Support other federal reporting like MARS, T-MSIS, PERM, Core Set.
• Translate policy into clear business rules and acceptance criteria.
• Prepare executive briefings and recommendations to leadership.
• Collaborate with State finance, MCOs, and vendors on timelines.
• Review and validate report logic and data mappings.
• Identify data quality risks and propose solutions.
• Mentor analysts and ensure knowledge backup.
• Stay current on CMS and State Medicaid changes.

Skills

Medicaid policy knowledge

Executive briefing

SQL data queries

CMS reporting

Stakeholder communication

Tools

SQL

Data mapping

Job description

Optum Insight is seeking a Senior Medicaid SME to anchor Medicaid data and CMS reporting within the IL EDW, translating policy into actionable business rules and ensuring data integrity.

Remote work is available nationwide with in-office requirements in Minneapolis or DC area four days per week. You will lead executive briefings, collaborate with state finance teams, and mentor analysts on Medicaid data flows and federal reporting requirements.