Senior Business Transformation Consultant- Medicaid Management Information Systems

International Business Machines Corporation; Capitola (CA); On-site; USD 150,000 - 210,000; Full time

Job summary

IBM Consulting is seeking a skilled Business Transformation Consultant focused on Medicaid and application automation in California. You will analyze Medicaid portfolios, identify automation opportunities using AI/GenAI, and guide modernization efforts across clinical, operational, and technical teams.

The role emphasizes policy compliance, CMS guidelines, and HIPAA considerations, with the on-site client engagement four days a week.

Qualifications

• Experience with Medicaid Management Information Systems (MMIS) and healthcare IT systems.
• Deep knowledge of Medicaid policies, compliance requirements, and program portfolio operations.
• Familiarity with CMS regulatory requirements governing state Medicaid programs.
• Experience translating policies into system and operational changes.
• Understanding of HIPAA security and data governance in Medicaid environments.

Responsibilities

• Drive automation transformation and analyze client application portfolios for automation opportunities.
• Advise on AI/GenAI applications and automation use cases in healthcare and government settings.
• Engage stakeholders across clinical, operational, and technical teams to align priorities.
• Develop business cases and roadmaps for modernization and digital transformation.
• Provide technical guidance on Medicaid-specific data requirements and policy implications.
• Contribute to program governance and strategic decision-making for transformation initiatives.
• Support cloud migration and modernization efforts, including AWS cloud transformation.

Skills

MMIS experience

Medicaid policy knowledge

CMS regulatory knowledge

HIPAA/compliance familiarity

Stakeholder management

Cloud migration familiarity

Job description

Introduction

A career in IBM Consulting is built on long-term client relationships and close collaboration worldwide. You’ll work with leading companies across industries, helping them shape their hybrid cloud and AI journeys. With support from our strategic partners, robust IBM technology, and Red Hat, you’ll have the tools to drive meaningful change and accelerate client impact. At IBM Consulting, curiosity fuels success. You’ll be encouraged to challenge the norm, explore new ideas, and create innovative solutions that deliver real results. Our culture of growth and empathy focuses on your long-term career development while valuing your unique skills and experiences.

Introduction

A career in IBM Consulting is built on long-term client relationships and close collaboration worldwide. You’ll work with leading companies across industries, helping them shape their hybrid cloud and AI journeys. With support from our strategic partners, robust IBM technology, and Red Hat, you’ll have the tools to drive meaningful change and accelerate client impact. At IBM Consulting, curiosity fuels success. You’ll be encouraged to challenge the norm, explore new ideas, and create innovative solutions that deliver real results. Our culture of growth and empathy focuses on your long-term career development while valuing your unique skills and experiences.

Your Role And Responsibilities

As a Business Transformation Consultant specializing in Application Automation, you will drive automation transformation for clients and analyze client application portfolios to identify automation opportunities. You will leverage your expertise in AI/GenAI, RPA products, and process/task mining tools to propose tailored automation solutions.

Your Primary Responsibilities Will Include

Preferred Healthy Care Industry.

• Medicaid Domain Leadership & Strategy: Serve as the primary subject matter expert on California Medicaid policies, MMIS applications, and CMS/Federal regulatory requirements. Provide strategic guidance on innovation initiatives aligned with CA Medicaid business objectives and the CAMMIS operating model governance.
• Business Requirements Analysis & Translation: Analyze complex Medicaid business requirements from Department of Healthcare Services stakeholders and translate them into clear technical specifications and implementation roadmaps for modernization and digital transformation initiatives.
• Stakeholder Engagement & Client Management: Build and maintain strong relationships across multiple business units within DHCS and CA Medicaid program portfolio. Serve as the primary consulting liaison between clinical, operational, and technical stakeholders to ensure alignment on innovation priorities and implementation timelines.
• Innovation Initiative Assessment & Planning: Evaluate proposed AI, automation, and modernization initiatives against Medicaid compliance requirements, operational feasibility, and program impact. Develop business cases and implementation strategies that maximize value delivery while maintaining regulatory compliance.
• Technical Guidance & Advisory Support: Guide technical teams on Medicaid-specific business constraints, data requirements, and policy implications. Ensure solutions align with state and federal healthcare regulations, including CMS requirements and HIPAA compliance.
• Program Governance & Recommendations: Contribute to the CAMMIS Innovation Program governance model by providing evidence-based recommendations on prioritization, resource allocation, and success metrics for transformation initiatives.
• Cloud Migration & Modernization Support: Leverage understanding of legacy MMIS applications and cloud migration principles to advise on strategic decisions related to AWS cloud transformation and system enhancement capabilities.

This position is on site to our client, four days per week.

Required Technical And Professional Expertise

Industry-Specific Knowledge

• Experience in Medicaid Management Information Systems (MMIS), healthcare IT systems, and managed care environments
• Deep expertise in Medicaid policies, compliance requirements, and Medicaid program portfolio operations
• Comprehensive knowledge of CMS regulatory requirements and federal healthcare policy mandates governing state Medicaid programs
• Experience implementing state and federal healthcare policy initiatives and translating policies into system and operational changes
• Understanding of HIPAA compliance, data governance, and security requirements in Medicaid environments
• Knowledge of Medicaid processes including eligibility, claims adjudication, provider management, and program integrity functions

Expertise in AI/GENAI

• Experience advising stakeholders on AI implementation challenges including data quality, bias mitigation, and regulatory compliance in healthcare
• Familiarity with automation frameworks to identify and prioritize AI/GenAI opportunities in legacy systems and modernization initiatives

Core Competencies

• Advanced analytical and consulting skills to assess business/IT portfolios and develop value-driven recommendations
• Strategic ability to align Medicaid business objectives with technology capabilities to drive innovation
• Strong business requirements analysis and translation of healthcare policies into technical specifications
• Excellent stakeholder management and relationship building across clinical, operational, and technical teams
• Change management expertise to guide organizations through modernization and transformation initiative

Preferred Technical And Professional Experience

Expertise in AI/GENAI

• Proven understanding of AI/GenAI applications in healthcare and government settings with ability to assess feasibility for Medicaid operations
• Knowledge of AI/automation use cases relevant to claims processing, eligibility determination, and program integrity functions