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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in leading end-to-end implementations of oncology utilization management solutions for health plans, ensuring compliance with regulatory and contractual requirements while managing complex technical integrations and project risks. Proficient in mentoring teams and utilizing project management tools to drive successful outcomes.
Highest-signal resume keywords
Implementation Program ManagementHealthcare Data StandardsProject Management Professional (PMP)Oncology Utilization ManagementTechnical Data Integration
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Program ManagementProject ManagementData IntegrationKPI TrackingUser Acceptance TestingOperational ReadinessClinical Policy ConfigurationBenefit Rules ConfigurationAuthorization WorkflowsRisk Mitigation
Soft Skills
Effective CommunicationProblem SolvingMentoringLeadershipCollaboration
Tools & Technologies
MondaySmartsheetJira
Certifications & Qualifications
Project Management Professional (PMP)
Industry Keywords
Healthcare PayerUtilization ManagementMedicare AdvantageManaged MedicaidCMS InteroperabilityNCQAHITRUSTX12 834/278HL7 FHIRPrior Authorization
Tech Stack
Tools & technologiesPMP
About the role
Key responsibilities & impact- Lead end-to-end implementation of Eviti’s oncology utilization management solutions for health plan clients across commercial, Medicare, and Medicaid lines of business.
- Lead planning and execution of complex, multi-workstream health plan implementations, including scope definition, project charters, integrated work plans, timelines, resource plans, and go-live readiness criteria.
- Manage a portfolio of concurrent implementations, balancing priorities, dependencies, and resources to meet contractual commitments.
- Serve as primary implementation lead and escalation point for client executives and project sponsors; facilitate kickoffs, steering committees, and status reviews.
- Coordinate technical integration workstreams involving eligibility and member files, prior authorization data exchange, provider data, reporting feeds, single sign-on, and portal configuration.
- Partner with Eviti’s clinical team to configure client-specific clinical policies, benefit rules, and authorization workflows.
- Ensure implementations meet regulatory, accreditation, and contractual requirements, including NCQA, HITRUST, state and federal utilization management timeframes, and CMS-0057-F requirements.
- Identify, track, and mitigate project risks, issues, and dependencies; drive decisions and escalate appropriately.
- Lead user acceptance testing, operational readiness, client and provider training, and post-go-live hypercare.
- Define, track, and report implementation KPIs to Eviti leadership.
- Own and continuously improve Eviti’s implementation methodology, templates, and tools.
- Support sales and account management with implementation scoping, timeline estimates, RFP responses, and client due-diligence requests.
- Mentor implementation team members and cross-functional partners on program management best practices.
Requirements
What you’ll need- Bachelor’s degree in business, healthcare administration, information systems, or a related field, plus 12+ years of relevant experience; an equivalent combination of education and experience will be considered.
- 12+ years of progressive program or project management experience, including substantial experience leading client implementations in a healthcare payer, utilization management, or health IT environment.
- Demonstrated success delivering enterprise-scale implementations for health plans, including complex technical data integrations.
- Recognized expert and go-to resource in implementation program management, with mastery across multiple job areas.
- Project Management Professional (PMP) certification preferred.
- Experience implementing oncology, specialty pharmacy, or prior authorization programs.
- Familiarity with healthcare data standards and exchange (e.g., X12 834/278, HL7 FHIR) and CMS interoperability rules.
- Experience supporting Medicare Advantage and Managed Medicaid implementations.
- Proficiency with project and portfolio management tools (e.g., Monday, Smartsheet, Jira).
- Ability to solve complex problems involving clinical, technical, operational, and contractual variables.
- Ability to work independently with limited oversight and establish operational plans.
- Ability to communicate effectively with executive leadership, clients, vendors, partners, and stakeholders.
- Ability to guide, coach, and train employees across the company.
- Ability to lead strategically important initiatives involving large, cross-divisional teams.
