PCG International Inc - Eligibility & Case Management SME bei PCG International Inc

PCG Consulting International, a certified MBE partner to Deloitte, is seeking an experienced Eligibility and Case Management SME with IES experience to join our team!!

The IES Business Analyst / Case Management SME serves as the critical link between policy, operations, and technology teams. This role defines and refines business workflows for intake, eligibility, and case management processes, ensuring system functionality aligns with program objectives and user needs. The analyst provides expertise in translating complex Medicaid and human services business processes into clear, actionable requirements for Integrated Eligibility Systems (IES).

Key Responsibilities

• Elicit, analyze, and document business and functional requirements for eligibility and case management workflows, including intake, renewals, and determinations.
• Develop comprehensive process maps illustrating current-state operations and optimized future-state designs.
• Author epics, user stories, and acceptance criteria in alignment with Agile delivery standards.
• Collaborate with cross-functional teams—including policy, development, QA, and program leadership—to ensure solutions meet business goals and compliance standards.
• Support user acceptance testing (UAT) and validate system functionality against documented requirements.
• Contribute to go-live readiness and post-implementation stabilization, assisting with issue triage, training, and change management.
   

This is a Remote contract that position (occasional travel may be required) that offers the opportunity to directly impact how individuals access vital benefits and services. As an IES Business Analyst / Case Management SME, you’ll ensure that policy intent is accurately reflected in system design—bridging the gap between business goals and technical execution in one of the most critical domains of public service delivery.
 

Ideal Background & Qualifications

• 5+ years of experience as a Business Analyst or Functional SME on Integrated Eligibility System (IES) or Medicaid modernization projects.
• Deep understanding of case management, renewals, self-service portals, and eligibility determination workflows.
• Proficient in Agile delivery methodologies, with hands-on experience using Jira, Confluence, or similar tools for requirement tracking and documentation.
• Strong stakeholder management skills and the ability to facilitate discussions across business, policy, and technical domains.
• Exceptional written and verbal communication skills, with a proven ability to produce clear documentation and actionable requirements.
• Bachelor’s degree in Information Systems, Public Administration, or a related field (or equivalent experience).  

Preferred Attributes

• Experience collaborating with state Medicaid agencies or consulting partners (e.g., Deloitte, Accenture, IBM).  
• Familiarity with federal and state policy frameworks impacting eligibility and case management.  
• Demonstrated success supporting system modernization or large-scale technology transformation projects in the public sector.