Project Manager, Prior Authorization and Referral Transactions

We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.

As a Project Manager, Prior Authorization and Referral Transactions, you will be responsible for the project management, operational coordination, and production support of Prior Authorization and Referral transactions and provider-facing workflows.

Responsibilities

• Manage and coordinate projects and enhancements supporting Prior Authorization and Referral transactions, workflows, and provider experiences.
• Serve as a primary point of contact for Production Support ticket issues, coordinating investigation, escalation, tracking, and resolution with appropriate business and technology partners.
• Partner with business, technology, EDI, interoperability, and other stakeholders to investigate and resolve transaction and workflow-related issues.
• Coordinate project activities including requirements gathering, documentation, milestone tracking, risk and issue management, testing, implementation readiness, and post-production support.
• Support analysis of Prior Authorization and Referral transaction behavior and provider workflows to identify root causes, recurring issues, and opportunities for improvement.
• Coordinate business testing activities for system enhancements and releases, including test scenario development, defect management, validation, and implementation support.
• Translate business and provider needs into clear requirements and work with technology partners to support solution delivery.
• Monitor project deliverables, dependencies, risks, and outstanding decisions and proactively escalate items that could affect delivery or the provider experience.
• Support intake and prioritization of enhancements, defects, and roadmap opportunities impacting Prior Authorization and Referral capabilities.
• Develop and maintain project documentation, workflow documentation, status reporting, issue tracking, and stakeholder communications.
• Facilitate cross-functional meetings and working sessions to drive decisions, remove blockers, and ensure clear ownership of deliverables.
• Support implementation and post-release monitoring to validate expected outcomes and quickly identify production issues.
• Act as a key operational and project resource for continuous improvement of Prior Authorization and Referral transaction capabilities and provider-facing workflows.

Requirements

• 5–7 years of healthcare-related work experience.
• Experience supporting Authorization and Referral workflows, preferably within payer, provider, EDI, or healthcare transaction environments.
• Demonstrated project management experience coordinating work across business and technology teams.
• Experience with production issue management, including investigation, triage, escalation, root-cause identification, and coordination through resolution.
• Experience supporting requirements gathering, business testing, implementation, and post-production activities.
• Strong analytical, problem-solving, and decision-making skills.
• Strong collaboration and teamwork skills with the ability to coordinate across multiple business and technology stakeholders.
• Strong written and verbal communication skills, including the ability to translate technical or transaction-related issues into clear business language.
• Ability to manage multiple priorities, project deliverables, and production issues in a fast-paced environment.
• Demonstrated growth mindset, adaptability, and willingness to develop deeper expertise in Prior Authorization and Referral capabilities.

Education

• Bachelor’s degree in Business Administration, Healthcare Administration, Information Systems, Project Management, or a related field preferred.
• Equivalent combination of education and relevant healthcare, Prior Authorization/Referral, EDI, or project management experience may be considered in lieu of a degree.

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility