Senior Medicaid Provider Management SME MMIS / MES Modernization
Client: New York State Department of Health (NYS DOH)
Engagement Type: Contract
Duration: March 2026 - August 2026
Hours: 40 hours per week
Travel: Occasional / Ad-hoc
Position Overview
The New York State Department of Health (DOH) is seeking a Senior Medicaid Provider Systems Consultant to support the design and procurement of a statewide Provider Management system.
This consultant will lead current-state analysis, future-state workflow design, and the development of functional and technical requirements for a Provider Management Module. The role will also support RFP development and define an implementation roadmap to modernize provider enrollment, credentialing, and provider data management processes.
This is a senior-level healthcare IT strategy role focused on Medicaid systems modernization.
Key Responsibilities
Provider Systems Strategy & Design
- Assess current-state provider enrollment, credentialing, and provider data management processes.
- Facilitate stakeholder workshops with DOH leadership and operational teams.
- Conduct gap analysis and design future-state workflows.
- Identify automation, integration, and compliance requirements.
Business & Technical Requirements Development
- Develop comprehensive Business Requirements Documentation (BRD).
- Define functional and technical system requirements.
- Establish system integration requirements (e.g., MMIS/MES, claims systems).
- Create requirements traceability documentation.
RFP Development & Vendor Evaluation
- Draft detailed RFP content for a Provider Management Module.
- Develop bidder questions, evaluation criteria, and scoring frameworks.
- Conduct market research on provider management system vendors.
- Support proposal evaluation and vendor selection activities.
Implementation Strategy
- Develop phased implementation roadmap and timeline.
- Define key performance indicators (KPIs) and measurable business outcomes.
- Identify risks and mitigation strategies.
- Support change management planning.
Required Qualifications
- Minimum 12 years of progressive experience in healthcare IT, Medicaid systems, or public health modernization.
- Demonstrated experience with Provider Management systems, including:
- Provider Enrollment
- Credentialing
- Provider Data Management
- Direct experience supporting Medicaid programs, MMIS, or Medicaid Enterprise Systems (MES).
- Proven experience developing business and technical requirements for enterprise system implementations.
- Experience drafting or leading RFPs for large-scale technology procurements.
- Bachelor's degree required.
Preferred Qualifications
- Master's degree.
- Experience working with a State Department of Health or Medicaid agency.
- Experience with Medicaid system modernization initiatives.
- Knowledge of CMS regulations impacting provider enrollment and compliance.
- Certifications in Project Management (PMP), Business Analysis (CBAP), or Agile methodologies.
What Success Looks Like
- A comprehensive, clearly documented Provider Management RFP.
- Defined future-state provider workflows.
- Established KPIs and measurable business outcomes.
- A realistic, phased implementation roadmap ready for vendor execution.