Successfully completed a 19 state Medicaid clinical migration for a large Health Plan

by admin on January 14, 2020

Client: Major Benefit Provider

Award-winning Fortune 50 provider of healthcare services for tens of millions of consumers through thousands of employer, government and union health plans.


• Benefit Provider needed to migrate 19 states Medicaid prescription drug plans in one benefit year and needed resources to lead the effort
• Scope of services included the review, identification, documentation of all clinical rules (Utilization Management, Step Therapy, Prior Authorization, QA support and ongoing operational maintenance)
• Client management wanted this client’s first experience to be a positive one
• The timeframe was tight, with the project overseen at the highest executive level

RMK Solution

• Planned, set up and administered a combined on-site, near-site and offshore coordinated delivery solution.
• Staffed and maintained the three sites with 60+ professionals for more than one year.
• Scheduled and directed shifts 7 days a week to support three implementation waves (May, June and October)
• Ensured ongoing transparency through overall project management and tracking with daily morning huddles and afternoon progress checkpoints
• Utilized Lean Six Sigma methodology in the definition and documentation of the Maintenance of Business process including needed controls (metrics)
• In parallel with migration effort documented requirements needed to develop tools for automating repeatable process steps supported by business rules


• Delivery was completed on time, under budget with lower than expected errors reported after the go-live date allowing the Command Center to shut down early
• The seamless, “invisible” solution led to increased business for the client
• The RMK team went on to perform additional engagements for the client, supporting Maintenance of Business the following year including automation tool development

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