Program Manager

Program Manager – Utilization Management

Location: Hartford, CT

Work Setup: Hybrid – 2–3 days onsite per week

Role Type: Contract

Role Overview

We are seeking a seasoned Program Manager – Utilization Management with strong experience in healthcare payer operations, Utilization Management (UM), and prior authorization. The ideal candidate will lead complex business and technology initiatives, drive enterprise program delivery, and coordinate cross-functional teams across clinical operations, technology, and business functions.

This role will focus on managing healthcare modernization programs, optimizing utilization management processes, improving prior authorization workflows, and ensuring alignment between clinical operations and technology delivery. The candidate must demonstrate strong program governance, stakeholder management, and the ability to deliver complex initiatives within healthcare payer environments.

Responsibilities

• Manage enterprise healthcare programs focused on Utilization Management (UM), prior authorization, and clinical operations.
• Oversee initiatives involving authorization workflows, medical necessity reviews, clinical decision support, and UM platform modernization.
• Coordinate cross-functional teams, including clinical operations, medical directors, nurses, business analysts, engineering teams, and external vendors.
• Manage program roadmaps, project timelines, budgets, resources, dependencies, and risks.
• Support integrations across UM platforms, member eligibility systems, claims platforms, provider systems, and clinical data repositories.
• Drive program governance, stakeholder reporting, executive communications, and release readiness.
• Partner with business and technology leaders to align program objectives with organizational priorities.
• Identify delivery risks, operational challenges, and dependencies, and develop mitigation strategies.
• Ensure program execution aligns with applicable CMS requirements, healthcare accreditation standards, and compliance expectations.
• Monitor program milestones, track delivery performance, and communicate progress to executive stakeholders.
• Drive collaboration between clinical and technical teams to ensure successful implementation of healthcare technology initiatives.

Required Skills

• Strong Program Management experience within healthcare payer environments.
• In-depth understanding of Utilization Management (UM), prior authorization, clinical review, and authorization lifecycle management.
• Experience working with Medicare, Medicaid, and/or commercial health insurance programs.
• Experience managing complex enterprise application delivery, transformation, and modernization initiatives.
• Strong understanding of healthcare payer operations and clinical workflows.
• Experience coordinating cross-functional teams across business, clinical, technology, and vendor organizations.
• Proven expertise in program governance, roadmap management, budgeting, resource planning, and risk management.
• Excellent leadership, communication, stakeholder management, and executive reporting skills.

Preferred Qualifications

• Knowledge of CMS prior authorization requirements and related healthcare regulatory expectations.
• Understanding of FHIR interoperability standards and healthcare data exchange.
• Experience with UM workflow automation and clinical systems integration.
• PMP and/or SAFe certifications.
• Experience managing large-scale healthcare technology transformation programs.

About Us

Moodys NWC is a result-driven management consulting firm headquartered in the Seattle metropolitan area. We specialize in best-fit consulting based on client needs, with a focus on all aspects of digital product management. We have an active role that we are looking to assist our premier client with and are looking for an experienced consultant with the right set of values. For us, personality fit is paramount. We are looking for self-starters who are experienced but flexible in their approach and have a customer-focused outlook. Our consultants go above and beyond, focus on the end goal, and do what it takes to deliver the desired results. If you are someone who fits the above job description, then please look at the specific opportunity and let us know why you are a good fit for Moodys NWC.

Our compensation reflects the cost of labor across several US geographic markets. The salary for this position ranges from $120,000 in our lowest geographic market up to $130,000 in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience. Other forms of compensation are offered in the form of medical, vision, and dental benefits. Moodys NWC believes in a culture of diversity, acceptance, and belonging.

We are committed to being an equal opportunity employer and hiring without discrimination, including based on race, color, creed, national origin, sex, marital status, age, sexual orientation, gender identity, disability, medical status, or veteran status. Moodys NWC complies with federal and state disability laws and makes reasonable accommodations for applicants and candidates with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, please submit a contact form here: https://moodysnwc.com/contact-us/