Project Consultant - Payment Integrity Strategy and Performance

Accountable for and manages the development, implementation and ongoing maintenance of project(s) with moderate to complex scope and deliverables. Project scope is at least two years planning to implementation and may impact one or more business unit/function. Project scope typically impacts one or more of the following: process, system, function, product and/or service.

• Develop detailed project plans and schedules, identify goals, objectives, risks and resource allocation. 
• Monitor project status for significant deviations in quality, cost or schedule. Interface with various departments, senior management and external individuals providing value and support for continuous improvement. 
• Support development of project budgets and update, as required. 
• Coach and mentor team members.  
• Provide feedback on team performance. 
• Ensure that expectations are developed, controlled, and executed in a timely manner. 
• Represent leadership staff at meetings in their absence. 
• May provide supervision to others. 

• Other duties as assigned.

   

"Qualifications"

• Bachelor's Degree in related field required.
• Five (5) or more years' experience in related field.
• Three (3) years project management experience in health plan operations or related field
• Project Management Professional Certificate preferred.
• Leadership and/or analytical experience with data, systems, and operations.
• Knowledge of program management preferred.
• Excellent analytical, organizational, problem solving, verbal and written communication skills.
• Knowledge of project management tools and methodologies.
• Ability to work independently, within a team environment and with multiple priorities.
• Proficient in current industry standard PC applications and systems (e.g., Access, Excel and Word).
• Ability to work closely with the technical support team in understanding and resolving systems issues.
• Ability to develop, implement, and monitor policies and procedures.
• Other related skills and/or abilities may be required to perform this job.

Departmental Summary:

• Centralizes contract oversight, negotiates terms, and ensures compliance; provides the expertise needed to evaluate vendor performance and manage relationships throughout the project lifecycle. 
• Supplies standardized project governance, status reporting, risk management, and resource coordination essential for multi‑vendor, multi‑phase initiatives.
  Handles post‑implementation support, system monitoring, and incident resolution; works closely with vendors to guarantee service level adherence after go‑live.
• Works with our finance team to assist with cost tracking, and financial reporting for vendor contracts and expenditures, fiscal responsibility.
  Provides functional expertise, validates that vendor deliverables meet business requirements, and facilitates user adoption and feedback during post‑implementation phases.
• Identifies, assesses, and mitigates risks related to vendor performance and project delivery, supporting robust contingency planning.

• Reviews contracts, ensures regulatory compliance, and mitigates legal risks associated with third‑party engagements.

   

Departmental Preferences:

• Proficiency in tools such as Microsoft Office (ex. Excel, PowerPoint), Power BI, Tableau, or other data visualization platforms is preferred.
• Strong communication skills and ability to support both Ad Hoc and recurring presentation and reporting needs for internal and external stakeholders is preferred.