Job Location: Available to work Remote, Salem,OR
Note: 15+ yrs. experience
Job Description:
The Office of Information Services (OIS) is a shared service provider for the Oregon Health Authority (OHA) and Department of Human Services (DHS). OIS provides the technology systems and services that support more than 18,000 OHA and DHS agency staff at local offices and facilities around the state. These systems and services help the two agencies determine client service program eligibility; provide medical, housing, food and job assistance; provide addiction, mental health, vocational and rehabilitative services; protect children, seniors and people with physical and/or developmental disabilities; process claims and benefits; manage provider licensing and state hospital facilities; and promote and protect the state public health.
SB 972 requires OHA to transition the Oregon Health Insurance Marketplace (OHIM) from a state-based marketplace using the federal platform (SBM-FP) to a state-based marketplace (SBM) using its own technology in time for open enrollment for plan year 2027. Specifically, OHA is required to procure and administer an information technology platform or service and call center, separate from the federal platform and call center, to provide electronic access to the health insurance marketplace in this state by November 1, 2026.
- OIS seeks an experienced Business Systems Consultant Manager IV to serve as a “Health Insurance Exchange Transition Consultant” who will provide technical expertise and guidance to the state of Oregon during this transition. This role requires in-depth knowledge of health insurance marketplace platform capabilities, CMS (Centers for Medicare & Medicaid Services) and IRS (Internal Revenue Service) security requirements, and the ability to review and recommend improvements to Request for Proposal (RFP) requirements.
- Contractor’s Key Person under this WOC will provide expertise throughout the various phases of the project. Contractor’s Key Person shall be responsible for:
- Platform Assessment: Evaluate the existing SBM-FP policies and identify technical capabilities, limitations, and areas for improvement. Understand the nuances of the CMS Federal Data Services Hub (FDSH) integration, and transition tasks and timelines.
- CMS Security Compliance: Ensure that the transition adheres to CMS security requirements, including data protection, access controls, and privacy standards.
- RFP Review: Analyze RFP documents related to the transition project, identifying gaps, ambiguities, and inconsistencies. Provide recommendations to align RFP requirements with best practices.
- Service Level Agreements (SLAs): Assess and suggest enhancements to SLAs, ensuring that they are clear, measurable, and align with the state's and CMS' expectations for the new SBE.
- Technical Recommendations: Provide technical guidance and recommendations to enhance the state's chosen SBM platform, optimizing its efficiency, scalability, and user-friendliness.
- Stakeholder Collaboration: Collaborate with state agencies, vendors, and CMS to facilitate a smooth transition process, addressing concerns and challenges effectively.
- Documentation: Create comprehensive technical reports and documentation outlining the transition plan, security measures, RFP revisions, and SLA recommendations.
Requirements
Skills Set:
- Consolidation planning and management
Required: 10 years
- Policy & standards analysis and implementation
Required: 7+ years
- Extensive experience in health insurance marketplace platforms, preferably with exposure to SBM go-live activities
Required: 3+ years
- In-depth knowledge of CMS & IRS security requirements and compliance standards
Required: -
- Proven experience in reviewing and revising RFPs and SLAs for complex technical projects
Required: -
- Strong analytical and problem-solving skills, with the ability to make data-driven recommendations
Required: -
- Excellent communication and interpersonal skills to work with diverse stakeholders
Required: -
- Project management skills to ensure timely delivery of transition milestones
Required: -
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