Business transformation leader- Payer & Health plan

Position Overview

We are seeking a senior-level consultant to serve as a Business Relationship Manager (BRM) and Technical Product Manager (TPM) supporting Health Plan technology and business leadership.

This individual will act as the primary liaison between Health Plan business leadership, IT leadership, product/platform teams, and delivery teams, with particular emphasis on the Health Payer ecosystem, HealthEdge/HealthRules Payer (HRP) and GuidingCare (GC).

The ideal candidate combines three capabilities:

1. Health Plan domain knowledge with a strong understanding of payer operations and terminology.
2. Health Plan technology knowledge, particularly HealthEdge/HealthRules Payer and GuidingCare.
3. Executive relationship management, with exceptional communication, presentation, facilitation, and stakeholder-management skills.

This is not primarily a hands-on technical delivery role. The consultant's value will be their ability to understand the business, establish trusted relationships, translate between business and technology stakeholders, surface issues and decisions, and ensure IT delivery leaders can focus on execution.

Key Responsibilities

Executive & Business Relationship Management

• Serve as a senior IT relationship point for Health Plan business and technology stakeholders.
• Build trusted relationships with executives, operational leaders, product owners, SMEs, and IT delivery teams.
• Understand business priorities, challenges, dependencies, and upcoming initiatives and translate them into actionable discussions with IT.
• Represent IT professionally in executive and cross-functional meetings.
• Proactively manage stakeholder expectations and ensure concerns are surfaced and addressed before they become escalations.
• Provide clear, concise executive communications regarding priorities, risks, decisions, dependencies, and overall progress.

Health Plan & Platform Liaison

• Bring strong working knowledge of healthcare payer operations and technology ecosystems.
• Understand how core payer platforms such as HealthEdge/HealthRules Payer and GuidingCare support Health Plan operations.
• Facilitate conversations between business SMEs and technical teams without requiring executives or delivery leaders to manage every interaction.
• Translate business language into technology context and technical issues into clear business implications.
• Identify when deeper platform, functional, architectural, or technical SMEs need to be engaged.

Program & Portfolio Coordination

• Maintain a high-level view across Health Plan initiatives, dependencies, risks, issues, and priorities.
• Ensure stakeholders have visibility into what is happening across major workstreams without creating unnecessary reporting overhead.
• Coordinate conversations across Product, Business Analysis/Requirements, Engineering, QA, architecture, vendors, and business stakeholders.
• Drive alignment around priorities, ownership, decisions, and next steps.
• Escalate issues appropriately while avoiding unnecessary escalation of routine delivery matters.

Executive Communication & Governance

• Develop and deliver polished, leadership-ready presentations and status updates.
• Facilitate executive and steering-level discussions.
• Clearly articulate business impact, technology considerations, risks, decisions, and trade-offs.
• Ensure meetings are decision-oriented with clear outcomes, owners, and next steps.
• Communicate comfortably with both senior executives and technical SMEs.

Required Qualifications

• 10+ years of experience in healthcare IT, payer technology, technical program management, business relationship management, product/program leadership, or a comparable role.
• Significant experience working within the health insurance / healthcare payer environment.
• Strong understanding of payer business processes and enterprise technology ecosystems.
• Working knowledge of HealthEdge/HealthRules Payer (HRP) and/or GuidingCare, with preference for candidates familiar with both.
• Demonstrated experience working directly with VP, SVP, EVP, CIO/CTO-level or comparable senior leadership.
• Excellent executive communication and presentation skills.
• Strong facilitation, negotiation, relationship-management, and conflict-resolution skills.
• Ability to translate complex business and technical topics into concise executive-level communication.
• Experience coordinating large, cross-functional technology initiatives involving business, IT, vendors, and platform partners.
• Ability to operate effectively in an environment with competing priorities, multiple initiatives, and complex dependencies.

Preferred Qualifications

• Experience with HealthEdge implementations, transformations, conversions, or major enhancement programs.
• Experience with GuidingCare or comparable care management/utilization management platforms.
• Experience operating in a BRM, TPM, program leadership, or technology relationship-management capacity within a health plan.
• Familiarity with payer functions such as claims, enrollment, provider, utilization management, care management, member services, and related operations.
• Experience working with large enterprise implementations and third-party technology vendors.