Executive Consultant/Medicaid, Medi-Cal Systems Integrator

Responsibilities

• Serve as a senior consultant supporting Medicaid/Medi-Cal, or state healthcare program initiatives.
• Provide systems and process integration support across business, technical, operational, policy, vendor, and program teams.
• Translate complex Medicaid/Medi-Cal program requirements, client priorities, and stakeholder needs into actionable work plans, process flows, decision materials, and implementation recommendations.
• Support data, integration, testing, functional advisory, project coordination, and implementation of readiness activities, as assigned.
• Apply Medicare and Medicare Advantage knowledge to support pharmacy benefit coordination, claims routing, payer responsibility analysis, and operational problem-solving.
• Facilitate collaboration across multiple stakeholder groups, including state program staff, IT teams, vendors, policy teams, operations teams, executive leadership, and external partners.
• Identify operational gaps, system dependencies, process risks, and implementation barriers; recommend practical mitigation strategies.
• Support requirements gathering, process mapping, workflow analysis, stakeholder interviews, meeting facilitation, decision tracking, and issue resolution.
• Develop clear, concise, executive-ready materials, including briefing documents, status updates, decision logs, risk summaries, process documentation, and implementation plans.
• Aid in governance, escalation, and coordination activities to ensure alignment across workstreams and timely resolution of issues.
• Monitor project milestones, dependencies, risks, and stakeholder commitments to support delivery of quality and accountability.
• Apply knowledge of Medicaid/Medi-Cal policy, operations, claims, eligibility, managed care, benefits, pharmacy, fiscal, or related healthcare program areas, depending on project assignment.
• Support compliance, audit readiness, documentation quality, and alignment with applicable state and federal healthcare requirements.
• Demonstrate high emotional intelligence when navigating sensitive conversations, competing priorities, stakeholder conflict, and organizational change.
• Build trust with clients by communicating clearly, following through commitments, and maintaining professionalism in high-pressure environments.
• Serve as a trusted advisor to executive leadership, providing strategic guidance, decision support, risk assessments, and recommendations related to large-scale public-sector technology transformation initiatives.
• Lead or support the design, implementation, and continuous improvement of governance frameworks, PMO structures, executive steering committees, decision-making processes, and performance management practices.
• Conduct organizational assessments to evaluate operating models, business processes, workforce readiness, governance maturity, and organizational effectiveness; develop recommendations for operational improvement and transformation.
• Provide oversight of service delivery performance, ensuring accountability for project outcomes, contractual obligations, service-level expectations, quality standards, and stakeholder commitments.
• Manage complex vendor ecosystems consisting of systems integrators, technology vendors, business partners, state agencies, and external stakeholders; facilitate alignment, issue resolution, and coordinated delivery across organizations.
• Lead transition planning, organizational readiness, change management, stakeholder adoption, communications, training coordination, and post-implementation stabilization activities.
• Support enterprise modernization efforts involving healthcare, human services, eligibility, benefits administration, program operations, fiscal systems, data platforms, and related public-sector technology environments.
• Monitor vendor performance, contractual deliverables, implementation commitments, and governance requirements; identify risks and recommend corrective actions to maintain delivery success.
• Develop and present executive-level governance materials, strategic roadmaps, organizational assessments, operational improvement recommendations, and transformation status reporting for senior agency leadership and executive stakeholders.
• Provide thought partnership to KAIP leadership on client needs, role clarity, delivery risks, and opportunities to strengthen service delivery.

Qualifications

• Strong knowledge of Medicaid, Medi-Cal, and public-sector healthcare or human services programs and operations.
• Ability to serve as a liaison across business, technical, operational, and policy domains, translating complex information into clear recommendations, implementation plans, and business solutions.
• Strong stakeholder engagement, facilitation, and consensus-building skills, with experience working across multi-vendor, multi-division, matrixed organizations, including government agencies, vendors, systems integrators, program leadership, and technical teams.
• Excellent written and verbal communication skills, including executive-level reporting, client-facing materials, meeting facilitation, decision documentation, and presentation of complex concepts to diverse audiences.
• Strong analytical, problem-solving, and risk management capabilities, including identifying dependencies, process gaps, implementation impacts, and developing mitigation strategies.
• Familiarity with California state project governance and oversight frameworks of procurement, and project management processes.
• High emotional intelligence, professionalism, diplomacy, and sound judgment, with the ability to influence without authority, navigate ambiguity, and operate effectively in high-visibility or politically sensitive environments.
• Ability to work independently, manage multiple priorities in a fast-paced consulting environment, and maintain alignment with leadership, client expectations, governance standards, and quality requirements.
• Proficiency with Microsoft Office, SharePoint, Teams, Visio, Jira, Smartsheet, Power BI, and similar collaboration, reporting, and project management tools.
• Experience with Medi-Cal systems and operations, including MMIS, claims processing, eligibility, managed care, pharmacy benefits, provider operations, data exchange, and fiscal systems.
• Demonstrated experience providing executive advisory services to agency executives, steering committees, and senior leadership.
• Experience leading large-scale public-sector technology transformation and modernization initiatives.
• Expertise in governance framework design, PMO establishment, portfolio oversight, and executive decision support.
• Experience managing large multi-vendor ecosystems, including systems integrators, technology vendors, implementation partners, and government stakeholders.
• Strong service delivery management skills, including contract accountability, performance monitoring, and delivery oversight.
• Experience conducting organizational assessments, operating model reviews, workforce readiness evaluations, and operational improvement initiatives.
• Expertise in organizational change management, transition planning, stakeholder adoption, and implementation readiness.
• Broad knowledge of public-sector healthcare and human services programs, including Medicaid/Medi-Cal, eligibility systems, benefits administration, and related state programs.
• Work/Education Experience:
  • Bachelor’s degree in Public Administration, Business Administration, Healthcare Administration, Information Systems, Public Health, Social Services, or related fields.
  • (Preferred) Master’s degree, PMP, Prosci, CSM, Lean Six Sigma, ITIL, or related certification.
  • 10+ years of experience in public-sector consulting, healthcare, human services, technology transformation, organizational improvement, program management, or systems modernization initiatives.
  • 5+ years providing executive advisory, governance, PMO, service delivery, or large-scale transformation leadership for state government, healthcare, or human services organizations.
  • Demonstrated experience working within complex multi-vendor environments and overseeing vendor performance, contractual obligations, and service delivery outcomes.
  • Experience supporting enterprise-scale technology implementations, modernization initiatives, organizational change efforts, and operational transformation programs.