Healthcare Project Manager

Job Summary

To support the transformation of healthcare services, the contract Healthcare Project Manager will define operating models, lead vendor transitions, and develop process frameworks while ensuring compliance with TRICARE and DoD guidelines.

Key responsibilities:

• Define and design the Target Operating Model (TOM) for the USFHP/TRICARE Prime environment, establishing end-to-end process frameworks
• Lead and support TPA transitions and insourcing programs, developing transition roadmaps and managing go-live readiness
• Develop process maps and SOPs aligned with TRICARE/USFHP requirements, ensuring seamless integration across member and provider interactions

Required qualifications:

• 10+ years of experience in healthcare consulting or payer operations
• Deep expertise in USFHP/TRICARE Prime and health plan setup or transformation
• Hands-on experience with multi-vendor operating environments, including TPA and PBM integrations
• Functional expertise in claims administration, care management, and provider network management
• Strong understanding of regulatory compliance, including TRICARE and HIPAA requirements