Sr Project Manager - Utilization Management

The Sr Project Manager (Sr PM) leads large-scale, complex, enterprise transformation initiatives within Healthfirst. This incumbent will provide dedicated leadership and project management oversight to the Utilization Management (UM) department to drive modernization efforts forward. This role is responsible for delivering complex, highly visible projects that drive operational accountability, cost efficiency, quality, compliance, and technology-enabled transformation. The Sr PM partners closely with UM leadership, clinical teams, technology partners, and enterprise stakeholders to redesign processes, establish new performance expectations, and enable AI and automation solutions that improve outcomes and scalability.

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, uti