Project Manager with Mandatory Prior Auth Experience
Location -RICHMOND, VA, Hybrid
Skill 1 - Yrs of Exp - 10+ - Healthcare IT Project Management & CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)
Skill 2 - Yrs of Exp - 6+ - Prior Authorization systems implementation healthcare operations: Claims, Eligibility, Provider Data
SKill 3 - Yrs Of Exp - 6+ - Risk management, Change management / change control
SKill 4 - Yrs Of Exp - 6+ - Healthcare Regulatory Projects, API Integration, Healthcare Compliance Projects
Preferred Qualifications:
Experience working with operating environments. PMP certification strongly preferred. Direct experience managing projects related to Prior Authorization systems is a strong plus. Proficiency with standard project management tools and documentation platforms (e.g., MS Project, SmartSheet, Jira, Confluence, SharePoint).
We are seeking a highly experienced Senior IT Project Manager to help lead the implementation of a complex initiative focused on developing and delivering two solutions to meet the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This is a high-impact role driving organizational alignment across Carelon business units (CBH, MBM, Client) in support strategic healthcare data platform. Key Responsibilities Lead end-to-end project management for a large-scale Prior Authorization system implementation, ensuring compliance with federal regulatory requirements (CMS-0057-F). Drive project execution across all phases: initiation, planning, execution, monitoring/control, and closure. Partner with internal stakeholders, including business and IT teams, to ensure delivery of a standardized output layer for integration with the OS platform. Oversee resource planning, stakeholder engagement, risk management, issue resolution, and change control. Provide regular updates, dashboards, and executive-level reporting on milestones and project health.
Required Qualifications 7+ years of IT project management experience, with a strong track record of delivering complex initiatives in healthcare environments. Proven ability to manage cross-functional teams in a matrixed enterprise setting. Deep understanding of healthcare operations, with working knowledge in claims, eligibility, and provider data. Demonstrated strength in team leadership, conflict resolution, and building trusted relationships across technical and non-technical stakeholders. Excellent communication skills, both written and verbal, with the ability to present to senior leadership. Deep technical background. Ability to understand development challenges so that issues can be adequately tracked.
Preferred Qualifications Experience working with data systems or within operating environments. PMP certification strongly preferred. Direct experience managing projects related to Prior Authorization systems is a strong plus. Proficiency with standard project management tools and documentation platforms (e.g., MS Project, SmartSheet, Jira, Confluence, SharePoint).
