Description Our client is looking for a skilled Eligibility and Enrollment Subject Matter Expert (SME) to join their team on a contract basis in Nashville, Tennessee (project is fully remote). In this role, you will play a pivotal part in assessing and improving Medicaid enrollment and eligibility operations, ensuring compliance with regulations and optimizing processes. This is an exciting opportunity to collaborate with cross-functional teams and contribute to the development of policies and best practices within the healthcare domain. This is not a Business Analyst role. It is more of a Director-level operations expertise role. Responsibilities: - Conduct detailed evaluations of Medicaid enrollment and eligibility operations, including workflows, staffing, and system configurations. - Identify inefficiencies, compliance risks, and process gaps within the enrollment lifecycle and recommend actionable improvements. - Analyze performance metrics to ensure accuracy, compliance, and timeliness in eligibility and enrollment processes. - Review and assess the configuration of eligibility and enrollment modules within the designated system and suggest enhancements. - Collaborate with IT and business teams to implement system improvements and refine operational processes. - Provide expert guidance on Medicaid regulations and their impact on eligibility and enrollment workflows. - Assist in creating and updating policies, procedures, training materials, and job aids for enrollment teams. - Support compliance reviews, audits, and reporting requirements to ensure regulatory adherence. - Share best practices and facilitate knowledge transfer across internal teams to promote continuous improvement. Requirements - At least 5 years of experience in Medicaid enrollment and eligibility (mandatory) processes, preferably within a health plan environment. - Comprehensive understanding of the Medicaid enrollment lifecycle, including eligibility verification, member enrollment, reconciliation, and reporting. - Strong knowledge of state Medicaid regulations and federal guidelines impacting eligibility and enrollment. - Practical experience with the designated system, specifically in eligibility and enrollment modules. - Familiarity with Agile Scrum methodologies and budget management processes. - Expertise in compliance, patient eligibility, and health care audits related to Medicaid and Medicare. - Proficient communication skills for collaborating with cross-functional teams and stakeholders. - Knowledge of tools such as TriZetto QNXT (mandatory) and experience with open, provider, and annual enrollment processes. Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use (https://www.roberthalf.com/us/en/terms) .