Texas Medicaid Ops Lead - UM/CM & Data Insights

Medicaid; Richardson (TX); Hybrid; USD 56,000 - 124,000; Full time

Job summary

HCSC in Richardson, TX is seeking a qualified professional to lead operational services and program implementation across Texas Medicaid functions including UM, CM, reporting, and enrollment. You will resolve complex questions and partner with internal teams to ensure state compliance, using data to drive performance improvements.

The role demands a business background with health insurance operations experience, strong communication, and project management skills.

Qualifications

• Bachelor's degree in Business with 4 years’ experience OR 8 years in health insurance operations.
• Experience in project development, implementation and execution.
• Experience interfacing with internal clients and operations personnel.
• Strong verbal and written communication and ability to represent Medicaid department.
• Experience managing multiple projects and coordinating priorities.
• Strong analytical, organizational, and interpersonal skills.
• Experience with Texas Medicaid UM/CM operations preferred.
• Knowledge of Texas Medicaid UMCM and UMCC requirements.

Responsibilities

• Provide operational services, assistance, and program implementation for day-to-day Medicaid functions (UM, CM, reporting, compliance, billing, claims, enrollment, customer service).
• Resolve complex and escalated internal or external operational questions.
• Collaborate with other areas to develop, test, and implement policies, reporting, and system changes to meet state requirements.
• Focus on Texas Medicaid managed care operations, interpreting UMCM/UMCC requirements and monitoring performance to identify gaps and support compliance.

Skills

Project management

Client interfacing

Verbal & written communication

Multi-project management

Leadership

Analytical skills

Organizational skills

Texas Medicaid UM/CM experience

Education

Bachelor Degree in Business

Tools

Power BI

Microsoft Excel (Advanced)

Job description

HCSC in Richardson, TX is seeking a qualified professional to lead operational services and program implementation across Texas Medicaid functions including UM, CM, reporting, and enrollment. You will resolve complex questions and partner with internal teams to ensure state compliance, using data to drive performance improvements.

The role demands a business background with health insurance operations experience, strong communication, and project management skills.