Duties and Responsibilities
Lead end-to-end delivery of complex, enterprise-wide (UM transformation) initiatives focused on operational efficiency, program transformation, technology enablement, and performance improvement
Drive UM modernization efforts through implementation of AI, automation, and advanced analytics solutions to improve medical necessity determinations, throughput, and decision accuracy
Translate strategic objectives into actionable project plans with clear scope, timelines, financial targets, and measurable outcomes for the UM department
Manage a high-volume portfolio of projects with significant cross-functional and technology interdependencies, including operations, clinical, medical management, finance, compliance/regulatory, and IT teams
Translate strategic objectives into actionable project plans with clear scope, timelines, financial targets, and measurable outcomes for the UM department
Apply project management best practices, tailoring methodologies as appropriate per initiative
Translate strategic objectives into actionable project plans with clear scope, timelines, financial targets, and measurable outcomes for the UM department
Establish and manage project governance, including executive steering committees, decision forums, and escalation pathways
Proactively identify and manage risks related to cost, scope, regulatory compliance, operational disruption, and change adoption
Track, validate, and report on financial and operational benefits, including cost savings, productivity gains, and return on investment
Ensure projects comply with healthcare regulations, internal controls, and quality standards.
Drive effective change management to support adoption, sustainability, and realization of UM transformation benefits
Provide clear, concise executive-level communication on progress, risks, dependencies, and realized value
Coach and mentor Project Coordinators and Project Managers
Additional duties as assigned
Minimum Qualifications
Bachelor’s degree from an accredited institution
Prior experience leading medium to large scale, complex projects within healthcare, health insurance, or other regulated environments
Strong executive presence with the ability to influence decisions and drive alignment across senior leaders and diverse stakeholder groups
Demonstrated expertise managing projects with significant operational and technology dependencies requiring analytical, communication, and problem-solving skills
Translate strategic objectives into actionable project plans with clear scope, timelines, financial targets, and measurable outcomes for the UM department
Preferred Qualifications
Master’s degree or advanced-level certification such as Project Management Professional (PMP), Program Management Professional (PgMP), Six Sigma, or Lean
Demonstrated experience delivering Utilization Management, medical management, or clinical operations transformation initiatives
Experience modernizing UM functions such as prior authorization, concurrent review, retrospective review, or denial management
Familiarity with UM platforms, clinical decision support tools, or AI-enabled utilization solutions
Experience partnering with clinical leaders and technology teams to implement AI, automation, or analytics solutions.
Experience supporting payer operations such as claims, utilization management, care management, provider operations, or enrollment
Proven success delivering cost efficiency, transformation, or enterprise change initiatives with measurable results
Experience with large-scale process redesign, automation, or technology-enabled transformation initiatives
Experience working in a Scaled Agile Framework (SAFe) environment
Knowledge and/or experience with multiple Agile techniques: User Stories, ATDD, TDD, Continuous Integration, Continuous Testing, Pair Programming, Automated Testing
Experience with application and/or systems implementations or upgrades
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $122,900 - $188,020
All Other Locations (within approved locations): $105,100 - $160,480
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.