Sr Consultant

Medicaid Waiver Evaluation Consultant

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector.

Summary: We are seeking a senior-level, detail-oriented and self-motivated Medicaid Waiver Evaluation Consultant to join our team. This role involves analyzing large healthcare datasets and interpreting results of quality measures, supporting strategic initiatives through data-driven insights.

Duties and Responsibilities:

Serves as project manager and subject matter expert within the practice including management of a team, and key projects related to waiver evaluation

Develops and executes new growth strategies

Identifies new sales opportunities and follow-up on sales leads

Analyze large-scale healthcare datasets with minimal supervision to extract actionable insights

Ensure data integrity, reproducibility, and compliance with regulatory and privacy standards

Utilize SQL, Power BI, and Databricks to calculate and report on standard and customized quality measure sets

Collaborate with cross-functional teams to define specifications for quality measures and key performance indicators (KPIs)

Document business processes and analytical methodologies to ensure transparency and repeatability

Develop and implement claims-based quality metrics to assess the performance of Medicaid programs

Analyze large datasets of Medicaid claims to identify trends, patterns, and insights

Collaborate with healthcare providers, policymakers, and other stakeholders to ensure the relevance and accuracy of quality metrics

Design and conduct statistical analyses to evaluate the impact of policy changes on Medicaid outcomes

Provide technical expertise and support to other team members on data analysis and interpretation

Lead the implementation of major project phases and contribute to project planning and execution

Prepares client deliverables, including written reports, presentations, and status updates

Lead client discussions and present findings and updates to clients in a clear and professional manner

Manages projects, staff, and tasks with limited supervision while meeting and exceeding performance expectations

Participates in sales and business development activities related to the practice, including leading proposal writing teams, including writing sections, coordinating efforts, and preparing proposal submissions

Independently manages complex projects, staff and tasks with limited supervision while meeting and exceeding performance expectations

Required Skills:

Experience with healthcare data standards (ICD, CPT, HCPCS, UB-04, 837/835 transactions)

Experience with healthcare utilization and quality metrics (NCQA/HEDIS, CMS Core Set)

Experience with health plan eligibility and enrollment data

Experience programming with R, Python, or other programming languages

Experience designing and implementing statistical models to assess the impact of interventions or policy changes, such as interrupted time series and difference-in-difference

Familiarity with reporting tools and dashboard design

Ability to translate complex regulatory requirements into practical system solutions

Master's in Data Science, Statistics, Public Health, Health Informatics, or a related field

Qualifications:

Education: Master's degree in information science, health economics, public health, health policy, healthcare administration or a related health or quantitative analysis field.

Experience: Minimum 5 years of relevant work experience, preferably at CMS institution.

Supervisory Responsibility:

Business Analyst

Consultants

Working Conditions:

Office Setting

Some travel required

Compensation:

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides a reasonable range of compensation for this role. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.

PCG does not sponsor newly hired foreign national workers for work authorization, including H-1B sponsorship.

EEO Statement:

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.