SME - Provider Lifecycle Management (AI-First Consulting)
1. Role Overview
We are seeking a Business, Technology & Performance Metrics Improvement SME - Provider Lifecycle Management (PLM) for our Healthcare Technology Consulting practice. You will partner with Health Plans and Systems to modernize core operations through AI, engineering, and data-driven transformation.
Requires deep expertise across PLM: Provider Network Management, Credentialing, Contracting, Primary Source Verification (PSV), Enrollment, Directory Management, and Data Architecture. You will lead client engagements, conduct AI diagnostics, design target architectures, and accelerate provider onboarding.
2. Key Responsibilities
AI Diagnostics & Operational Assessments
Lead PLM diagnostic assessments to evaluate processes, technical architecture, and data bottlenecks.
Deploy AI and process mining to analyze workflow latency and data quality leaks.
Benchmark operations against regulatory standards (NCQA, URAC, CMS, No Surprises Act) and build ROI blueprints.
PLM Domain & Business Optimization
Serve as principal SME across Provider Data Management (PDM), Credentialing, CAQH integration, and Directory Accuracy.
Architect onboarding journeys that streamline PSV, automate rosters, and reduce manual entry.
Define data quality standards for Provider MDM, SSOT models, and NPI structures.
AI Solution Design & Technology Improvement
Partner with engineering teams to build AI-first PLM tools, automation agents, and integration engines.
Architect GenAI/LLMs for contract parsing, NLP for roster ingestion, and OCR for credentialing.
Design API integrations with Core Systems (Facets, QNXT), EHRs, NPDB, and Salesforce Health Cloud.
Performance Metrics & Operations
Track and optimize core PLM metrics:
Time-to-Network: Reduce onboarding from 90-120 days to Touchless Automation: Maximize straight-through processing for rosters and PSVs.
Directory Accuracy: Achieve >98% accuracy to comply with No Surprises Act.
Cost & CSAT: Lower unit costs and boost provider satisfaction.
Build real-time dashboards and telemetry for executive visibility.
The individuals needs to work from VNS office 3 days a week
