Strategic Interoperability Consultant CMS PA & Medicaid MMIS

Overview

Remote
Depends on Experience
Contract - W2
Contract - Independent
Contract - 1 Year(s)
No Travel Required

Skills

HL7 FHIR
Interoperability
MMIS
Prior Authorization

Job Details

Contract Opportunity
Location: Remote (preferred PST hours, Sacramento, CA)
Duration: 12 months (Contract)


We re hiring a seasoned consultant to lead CMS Interoperability & Prior Authorization compliance within Medicaid/MMIS programs. This is a high-visibility, high-pressure role where you ll engage directly with state executives, CMS liaisons, and technology vendors.

This isn t a traditional BA role you ll be the trusted advisor and strategist, helping leadership navigate mandates, secure stakeholder buy-in, and bridge the gap between program strategy and technical implementation.

What You ll Do

  • Lead executive and stakeholder sessions with state leadership, CMS, and vendors.

  • Drive gap assessments & compliance analysis for CMS Interoperability & PA Final Rule.

  • Provide executive-level insights and roadmaps to guide Medicaid/MMIS modernization.

  • Collaborate across business, clinical, and IT teams to define requirements and system impacts.

  • Interpret HL7 FHIR & ASC X12 standards and advise on adoption strategies.

  • Act as the glue between state leadership and vendors to keep initiatives on track.

What We re Looking For

  • 8+ years in healthcare IT consulting (Medicaid/MMIS required).

  • Strong knowledge of CMS Interoperability & Prior Authorization mandates.

  • Experience working with state executives, CMS, and tough stakeholders in complex programs.

  • Strong command of HL7 FHIR, ASC X12, and Medicaid data exchange.

  • Leadership presence with the ability to thrive in high-pressure environments.

  • Hands-on experience with Medicaid Enterprise Systems (MMIS) modernization.

  • Strong knowledge of FHIR APIs, HL7 standards, and interoperability frameworks.

  • Experience with EDI transactions (X12 278, 834, 837, 835, etc.) in Medicaid/Payer systems.

  • Background in Prior Authorization automation, clinical workflows, or policy implementation.

  • Experience designing or advising on API-led integration strategies for healthcare programs.

  • Familiarity with MITA 4.0 and state Medicaid compliance initiatives.

If you re a strategic consultant who can manage tough clients, complex dynamics, and executive-level conversations while guiding technical teams toward compliance success we want to talk to you.

Apply today to join this remote, 12-month contract supporting California s Medicaid modernization initiatives.

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