Senior Project Manager- Clinical Transformation

Description and Requirements

The Sr Project Manager Clinical Transformation (Sr PM) uses their deep knowledge of clinical operations business processes, regulations, and technology to lead large-scale, complex initiatives focused on the implementation of Utilization Management (UM), Care Management (CM), and related clinical operations platforms across Healthfirst. The Sr PM is accountable for delivering complex software implementation and transformation programs from initiation through stabilization, ensuring operational adoption, regulatory alignment, measurable business outcomes, and cross-functional coordination. The incumbent drives implementation, governance, operational readiness, vendor coordination, clinical workflow integration, and delivery accountability for technology-enabled transformation programs in support of the Clinical Operations team.

Duties and Responsibilities:

• Lead end-to-end implementation of AI-enabled clinical platforms supporting UM, Care Management, prior authorization, population health, or related clinical operations
• Manage large-scale transformation initiatives involving workflow redesign, system integration, data migration, operational readiness, and change management
• Translate strategic objectives into actionable project plans with clear scope, timelines, financial targets, and measurable outcomes
• Manage a high-volume portfolio of large, cross-functional projects with significant operational, clinical, technical, financial, and regulatory interdependencies
• Translate operational and clinical requirements into executable implementation plans with technology teams and vendors
• Ensure AI solutions align with clinical operations, compliance standards, audit requirements, and user adoption objectives
• Partner with executive and senior leaders to drive alignment, facilitate decision making, remove barriers, and ensure accountability across stakeholder groups
• Standardize and apply project management best practices, tailoring methodologies as appropriate to initiative complexity and scope
• Establish and maintain project governance structure, including steering committees, status reporting, risk management, and escalation pathways
• Proactively identify and mitigate risks related to cost, scope, timelines, regulatory compliance, operational disruption, and organizational readiness and adoption
• Monitor and report on initiative performance, operational impact, financial benefits, and realization of return on investment
• Ensure projects are executed in accordance with Healthfirst policies, regulatory requirements, internal controls, and quality standards
• Drive effective change management to support adoption, sustainability, and realization of operational and business outcomes
• Provide clear, concise executive-level communications and presentations regarding project status, risks, dependencies, deliverables, and realized value
• Mentor and support Project Coordinators and Project Managers through coaching, project guidance, and operational leadership
• Perform additional duties as assigned

• Bachelor's degree from an accredited institution or equivalent work experience
• HS Diploma or GED from an Accredited Institution
• Prior experience leading medium-to-large-scale, clinically focused projects within healthcare or health insurance
• Demonstrated experience delivering AI-enabled platforms, advanced analytics solutions or new software platforms solutions within healthcare operations
• Experience managing enterprise software implementations with vendors, systems integrators, and internal IT teams
• Experience requiring executive presence 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
• Experience applying project delivery methodologies, with proven ability to tailor approaches depending on goals/initiatives

• Master's degree from an accredited institution
• Advanced-level certification such as Project Management Professional (PMP), Program Management Professional (PgMP), Certified Professional in Healthcare Quality (CPHQ), or Lean
• Experience supporting technology implementations, system upgrades, platform migrations, or technology modernization initiatives
• Industry experience in healthcare, including managed or long-term care, health insurance, hospital long-term care, government or other healthcare agency
• Experience implementing clinical, Utilization Management, or Care Management healthcare technology platforms
• Knowledgeable of Department of Health (DOH) and Center for Medicare & Medicaid Services (CMS) regulations
• Experience leading teams focusing on professional growth and development and organizational goals