Senior Business Transformation Consultant- Medicaid Management Information Systems

IBM
IBM

Remote

Posted on Oct 16, 2026
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 education
Bachelor's Degree
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

ABOUT BUSINESS UNIT

IBM Consulting is IBM’s consulting and global professional services business, with market leading capabilities in business and technology transformation. With deep expertise in many industries, we offer strategy, experience, technology, and operations services to many of the most innovative and valuable companies in the world. Our people are focused on accelerating our clients’ businesses through the power of collaboration. We believe in the power of technology responsibly used to help people, partners and the planet.

YOUR LIFE @ IBM

In a world where technology never stands still, we understand that, dedication to our clients success, innovation that matters, and trust and personal responsibility in all our relationships, lives in what we do as IBMers as we strive to be the catalyst that makes the world work better.

Being an IBMer means you’ll be able to learn and develop yourself and your career, you’ll be encouraged to be courageous and experiment everyday, all whilst having continuous trust and support in an environment where everyone can thrive whatever their personal or professional background.

Our IBMers are growth minded, always staying curious, open to feedback and learning new information and skills to constantly transform themselves and our company. They are trusted to provide on-going feedback to help other IBMers grow, as well as collaborate with colleagues keeping in mind a team focused approach to include different perspectives to drive exceptional outcomes for our customers. The courage our IBMers have to make critical decisions everyday is essential to IBM becoming the catalyst for progress, always embracing challenges with resources they have to hand, a can-do attitude and always striving for an outcome focused approach within everything that they do.

Are you ready to be an IBMer?

ABOUT IBM

IBM’s greatest invention is the IBMer. We believe that through the application of intelligence, reason and science, we can improve business, society and the human condition, bringing the power of an open hybrid cloud and AI strategy to life for our clients and partners around the world.

Restlessly reinventing since 1911, we are not only one of the largest corporate organizations in the world, we’re also one of the biggest technology and consulting employers, with many of the Fortune 500 companies relying on the IBM Cloud to run their business.

At IBM, we pride ourselves on being an early adopter of artificial intelligence, quantum computing and blockchain. Now it’s time for you to join us on our journey to being a responsible technology innovator and a force for good in the world.

IBM is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, neurodivergence, age, or other characteristics protected by the applicable law. IBM is also committed to compliance with all fair employment practices regarding citizenship and immigration status.

OTHER RELEVANT JOB DETAILS

IBM offers a competitive and comprehensive benefits program. Eligible employees may have access to:

- Healthcare benefits including medical & prescription drug coverage, dental, vision, and mental health & well being

- Financial programs such as 401(k), cash balance pension plan, the IBM Employee Stock Purchase Plan, financial counseling, life insurance, short & long- term disability coverage, and opportunities for performance based salary incentive programs

- Generous paid time off including 12 holidays, minimum 56 hours sick time, 120 hours vacation, 12 weeks parental bonding leave in accordance with IBM Policy, and other Paid Care Leave programs. IBM also offers paid family leave benefits to eligible employees where required by applicable law

- Training and educational resources on our personalized, AI-driven learning platform where IBMers can grow skills and obtain industry-recognized certifications to achieve their career goals

- Diverse and inclusive employee resource groups, giving & volunteer opportunities, and discounts on retail products, services & experiences

We consider qualified applicants with criminal histories, consistent with applicable law.

This position was posted on the date cited in the key job details section and is anticipated to remain posted for 21 days from this date or less if not needed to fill the role.

IBM will not be providing visa sponsorship for this position now or in the future. Therefore, in order to be considered for this position, you must have the ability to work without a need for current or future visa sponsorship.

The compensation range and benefits for this position are based on a full-time schedule for a full calendar year. The salary will vary depending on your job-related skills, experience and location. Pay increment and frequency of pay will be in accordance with employment classification and applicable laws. For part time roles, your compensation and benefits will be adjusted to reflect your hours. Benefits may be pro-rated for those who start working during the calendar year.

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