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 or equivalent work experience
• 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

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.


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All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

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.