Sr Project Manager - Utilization Management

• 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
• Apply project management best practices, tailoring methodologies as appropriate per initiative
• 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

• 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

• 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

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions