Business Systems Consultant Manager IV [Must Have Health Insurance Marketplace]

Job Title: Business Systems Consultant Manager IV [Must Have Health Insurance Marketplace]

Location: Salem, OR/REMOTE

Duration: 12+ Months

Work schedule is typically Monday - Friday with the part-time hours between 8 AM - 5 PM Pacific Standard Time.

Remote work/Telecommuting will be contingent upon the key person providing their own adequate office equipment and connectivity.

1. 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.

Required skills and experience:

• Bachelor's degree in a relevant field (e.g., Computer Science, Healthcare IT, or related)
• Extensive experience (3+ years) in health insurance marketplace platforms, preferably with exposure to SBM go-live activities.
• In-depth knowledge of CMS & IRS security requirements and compliance standards.
• Proven experience in reviewing and revising RFPs and SLAs for complex technical projects.
• Strong analytical and problem-solving skills, with the ability to make data-driven recommendations.
• Excellent communication and interpersonal skills to work with diverse stakeholders.
• Project management skills to ensure timely delivery of transition milestones.
• Policy & standards analysis and implementation (7-9 years of experience)
• Consolidation planning and management (10+years of experience)

Full-time professional Information Technology Project Development experience and/or Function/Business Process Analysis with at least one (1) year of experience in an Administrative; Managerial; or Supervisory capacity.

Substitutions: Accredited college training may substitute for the required work experience, except for the supervisory experience, with a maximum substitution of four (4) years. (Fifteen (15) semester hours in Information Technology or a related area is required.)

Accredited graduate training in the above area may substitute for the required work experience, except for the supervisory experience, with a maximum substitution of two (2) years.

Successfully completion of an Information Technology Certification program, may substitute for the required work experience with a maximum substitution of two (2) years. (Proof of certification must accompany application.)

Two (2) years of work experience as a Project Manager-Senior; Quality Assurance Manager; Project Manager-Intermediate may substitute for all of the required experience.

Our primary criteria are the qualifications and experience of the proposed key person. Please propose your strongest candidate, at a rate less than or equal to the maximum.

Interviews will be conducted via MS Teams. Interview times will reflect Pacific Standard Time.

Due to circumstances beyond our control, we anticipate two weeks or more for the background check completion for the selected candidate.

The selected key person could potentially telecommute, as agreed to between the Agency Authorized Representative and the key person. Any decision to allow telecommuting is made with the understanding that decision will be re-evaluated by the Agency Authorized Representative on a regular basis. The key person should be available to work onsite within a reasonable timeframe.

Telecommuting will be contingent upon the key person providing his/her own adequate computer, monitor(s), Internet connection, and telephone, and be readily available during normal working hours via phone, email or instant message. Access to Agency systems will be provided via VPN or similar software. No hardware or additional software will be provided at the key person's home site or his/her PC.