Estimated Duration: 12+ months with possible extensions
Work Setting: Hybrid, 25% onsite and 75% remote
Only candidates able to relocate as required should apply to avoid removal from future consideration.

Required:
Experience with CMS Interoperability and Patient Access Final Rule (CMS-9115-F) and CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) compliance implementation (required);
Experience with FHIR R4/R5 API development and cloud-hosted FHIR API servers (FHIR version 4.0.1 or greater);
Experience with FHIR implementation guides including US Core IG (USCDI), CARIN Consumer Directed Payer Data Exchange (CARIN BB) IG, HL7 Da Vinci PDex IG, Da Vinci PDex US Drug Formulary IG, and Da Vinci PDex Plan-Net;
Experience with SMART on FHIR authorization (Application Launch Framework Implementation Guide Release 1.0.0) and OAuth 2.0/OpenID Connect 1.0;
Experience with Patient Access API, Provider Access API, and Payer-to-Payer API design and implementation;
Experience with consent and identity management systems for health plan member data access;
Experience with third-party SMART on FHIR application onboarding, developer portal/sandbox management, and security risk assessments;
Experience with data integration from state government or Medicaid Management Information Systems (MMIS) and healthcare data warehouses (Azure);
Experience with healthcare claims, encounters, clinical data (USCDI v1+), and drug formulary data transformation to FHIR-compliant formats.
Experience with health plan data including claims, encounters, clinical data (USCDI v1+), and drug formulary data;
Experience with Medicaid, Medicare Advantage, or Federally Facilitated Exchange health plan systems;
Experience with requirements traceability matrices (RTM) and formal project implementation methodologies;

Responsibilities include but are not limited to the following:
Implement and support Patient Access API, Provider Access API, and Payer-to-Payer API in compliance with CMS-9115-F and CMS-0057-F within 6 months of project start;
Develop and maintain a cloud-hosted FHIR API server (FHIR R4/R5) with façade data model integrating claims, encounters, clinical data, and drug formulary data from SD MMIS and Data Warehouse;
Build and manage consent and identity management capabilities supporting OAuth 2.0/OpenID Connect and SMART on FHIR application authorization;
Establish and maintain a developer portal/sandbox for third-party SMART on FHIR application registration, onboarding, security attestation, and risk assessment;
Serve as primary project manager and technical lead, preparing project plans, managing risks and issues, change control, and delivering monthly status and CMS compliance reports;
Provide ongoing system maintenance, incident and error reporting, tier 1 customer support, and enhancements to ensure continued regulatory compliance throughout the contract term;
Conduct training and provide self-service training materials for DSS staff (3–5 users) on platform functionality, modules, and user provisioning.