Project Manager II

Title: Project Manager II
Location: Richmond, VA

Healthcare IT Project Management & CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)
Prior Authorization systems implementation healthcare operations: Claims, Eligibility, Provider Data
Risk management, Change management / change control
Healthcare Regulatory Projects, API Integration, Healthcare Compliance Projects

Description:
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 of Health s 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 Health 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 Health 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).