Medicaid Enterprise Systems and Policy Principal

As part of MITRE’s Center for Transforming Health, the CMS Programs Division is responsible for managing work shaping, engagement, and end-to-end delivery for the Health FFRDC’s CMS Portfolio with the Centers for Medicare & Medicaid Services (CMS). This position provides senior technical leadership at the intersection of Medicaid Enterprise Systems (MES) certification, cybersecurity, privacy, and cross-agency data integration.

Roles & Responsibilities:

In this role, you will be supporting large, complex engagement teams to address programmatic, policy, operational, strategic, and/or acquisition needs for CMS programs. As part of a team, you will have the opportunity to work closely with CMS to develop and implement evidence-based strategies and solutions to address some of the agency’s most complex challenges, with a focus on Medicaid enterprise systems, cross-agency data sharing, and data modernization., * Provide senior technical expertise on Medicaid enterprise systems, health IT modernization, and Medicaid Enterprise Systems (MES) certification, including Streamlined Modular Certification (SMC) reviews, certification recommendations, and corrective action plan (CAP) assessments; translate federal and state requirements into practical implementation guidance.

• Contribute subject matter expertise for cross-agency data-integration initiatives, coordinating federal partner agencies, state agencies, and contractors on planning, milestones, dependencies, risks, and status reporting to federal leadership.
• Elicit, analyze, and document stakeholder needs, operational processes, system capabilities, and functional requirements; identify gaps and dependencies and translate findings into clear requirements, process improvements, solution recommendations, and implementation priorities.
• Assess technical designs, system documentation, and data-integration approaches for security, privacy, interoperability, compliance, and operational risks; develop clear recommendations to address identified issues.
• Lead the development, review, and execution of data-sharing, privacy, security, and technical agreements, such as Computer Matching Agreements (CMAs), Information Exchange Agreements (IEAs), and Interconnection Security Agreements (ISAs), that enable appropriate and secure exchange of health information across organizations and systems.
• Translate evolving Medicaid and health care policy and program requirements into actionable analyses, recommendations, briefings, and decision-support materials for federal stakeholders.
• Identify emerging health care trends, risks, and implementation challenges and recommend practical approaches to improve program effectiveness and outcomes.

• Typically requires a minimum of 10 years of related experience with a Bachelor’s degree; or 8 years and a Master’s degree; or a PhD with 5 years’ experience; or equivalent combination of related education and work experience.
• At least 5 years of experience with Medicaid programs or Medicaid enterprise systems at the federal or state level, or equivalent experience supporting state Medicaid agencies as a vendor or consultant.
• Demonstrated subject-matter expertise in one or more core Medicaid domains, such as eligibility and enrollment, financing, managed care, waivers and demonstrations, quality, program integrity, long-term services and supports, or Medicaid enterprise systems.
• Demonstrated experience conducting or supporting Medicaid Enterprise Systems (MES) certification or recertification activities, including operational-readiness reviews, evidence analysis, findings, certification packages, recommendations, or corrective-action support.
• Experience conducting or supporting technical-design, security, privacy, compliance, or risk reviews for complex health IT systems.
• Strong ability to synthesize complex policy, operational, technical, analytic, and stakeholder inputs into clear findings, recommendations, decision materials, and implementation guidance; communicate effectively with technical, legal, privacy, operational, and executive stakeholders.
• This position requires a minimum of 3 days a week on-site., * Advanced degree in health policy, public policy, public administration, public health, law, health administration, or a related field.
• Experience with Medicaid Enterprise Systems (MES) certification criteria, Streamlined Modular Certification (SMC), operational-readiness reviews, or certification-recommendation packages.
• Experience with privacy and security agreements supporting government data sharing, including Computer Matching Agreements (CMAs), Information Exchange Agreements (IEAs), Interconnection Security Agreements (ISAs), Memoranda of Understanding (MOUs), and Data Use Agreements (DUAs).
• Knowledge of security and privacy principles applicable to health data and government information systems, including risk identification, mitigation planning, data protection, and secure information sharing.
• Experience with interoperability, data exchange, identity and access management, cloud services, or cross-agency data-integration initiatives.
• Familiarity with CMS security and privacy frameworks for state Medicaid and Exchange systems, such as ARC-AMPE and ARS, and with federal verification services such as the Federal Data Services Hub.
• Experience reviewing or developing technical, privacy, security, legal, or data-sharing documentation that supports data exchange or system-to-system integration.
• Experience providing technical assistance, training, and state-facing guidance for complex technology or compliance initiatives.
• Ability to manage multiple projects simultaneously in a fast-paced environment.
• Capability in another health domain area (e.g., cybersecurity, analytics, information technology).
• Ability to work with interdisciplinary teams.

This requisition requires the candidate to have a minimum of the following clearance(s)

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