Service-Disabled Veteran-Owned Small Business (SDVOSB)

PM-Engagement Manager IV&V – IA585480


This is a Contract position in Des Moines, IA posted January 30, 2019.

Location: Des Moines, IA
Pay Rate: $103/hr w-2 with benefits
Duration: 6 months with extensions
Start Date: ASAP
Position ID: IA585480

The Program Manager/Engagement Manager 2 (PREM2) will have technical and functional skills including Medicaid business, project management, and independent validation and verification (IV&V) expertise.

Candidate must be experienced in MMIS and/or Medicaid eligibility system projects, have working knowledge of HIPAA, and have provided IV&V services for similar-sized projects with similar complexities, inter-dependencies, and coordination requirements. Candidate will utilize industry standards and best practices in performing IV&V oversight and progress reporting activities.

Background on Projects that May Require IV&V Services
Program Integrity System Certification- beginning December 2018
Medicaid’s Program Integrity system has been in production since 2017 and requires CMS certification. It is anticipated that the certification will begin at the R3 Milestone Review. The backbone of the solution is Truven’s (now owned by IBM) DataProbe System®. IBM hosts the system with Iowa’s PI database in their secure, SSAE-16 compliant, national data center in Dallas, TX. The overall solution meets the CMS MECT Certification Checklist Requirements for Program Integrity System Functionality. The following implementation activities were carried out to implement a comprehensive program integrity solution for Iowa:

• Implement a Program Integrity Database – Build an analytic database with claims and other data sources useful to produce algorithms and models to identify fraud, waste and abuse in Iowa’s Medicaid Program.
• Develop Surveillance and Utilization Review System – Profiles by peer group that identify providers and service recipients who are statistical outliers on multiple parameters of cost, utilization, quality of care, and/or other metrics.
• Develop and implement custom analytics for Iowa – Custom algorithms developed to find fraud, waste and abuse for Iowa Medicaid Enterprise.
• Running Vulnerability Assessment – review of one to many years of data where Truven runs paid claims data through its Software as a Solution (SaaS) software, flagging claims that appear to be over-payments or billing errors and produce a report to prioritize the algorithm development.
• Develop and Implement Provider Surveillance Reports – Reports which provide Provider Risk Scores based on their inclusion or exclusion in eight data file.
• Validation of Encounter Data – Compare encounter data to historical FFS data by multiple measures to assess: validity, completeness and reasonableness.
• Implement an Investigatory Case Management System


Independent validation and verification program expertise. Technical & functional skills including Medicaid business & project management. 5 Years Required
Experience in MMIS and/or Medicaid eligibility system projects. 5 Years Required
Experience providing IV&V services for similar-sized projects with similar complexities, interdependencies, and coordination requirements. 2 Years Required
Working knowledge of HIPAA rules, policies, and procedures   Desired








Salary: $103/hr w-2 with benefits

Benefits: Health Insurance Stipend, Holiday Pay, Paid Time Off (PTO), Student Loan Repayment (Quarterly)

How to Apply

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