Consulting Manager, Healthcare Project Manager

Cognizant; Charleston (WV); Remote; USD 81,000 - 130,000; Full time

Benefits offered by this job

Medical/Dental/Vision/Life Insurance

Paid holidays + PTO

401(k) plan and contributions

Long-term/Short-term Disability

Paid Parental Leave

Employee Stock Purchase Plan

Job summary

Cognizant is seeking a Consulting Manager, Healthcare Business Transformation, to lead LTSS assessments across authorization, claims, provider, member, and financial workflows. You will analyze Pega and QNXT integrations, identify data gaps, and collaborate with stakeholders to design remediation roadmaps and transformation strategies.

You will facilitate workshops and executive sessions, develop business cases, and drive improvements in operational performance and risk reduction for healthcare

Qualifications

• Bachelor's degree or equivalent in Healthcare Administration, Information Systems, Business, or related field.
• 8+ years of experience in healthcare consulting, business transformation, program management, or healthcare operations.
• Strong experience with QNXT and healthcare payer platforms, including claims, benefits, enrollments, and authorization workflows.
• Experience working with Pega-based healthcare workflows, care management, or authorization management processes.
• Proven expertise in healthcare process analysis, stakeholder management, business requirements, and current-state/future-state process mapping.
• Experience conducting system integration reviews, data lineage assessments, reconciliation analysis, and business impact evaluations.
• Strong communication and executive presentation skills with the ability to influence stakeholders across business and technology organizations.
• Experience creating executive-level deliverables, recommendations, remediation roadmaps, and transformation strategies.

Responsibilities

• Lead end-to-end assessment and documentation of LTSS business processes across authorization, claims, provider, member, and financial workflows.
• Analyze interactions between Pega, QNXT, and related healthcare platforms to identify process, integration, and data flow gaps.
• Evaluate authorization-to-claims transaction integrity, data mappings, and operational controls to identify root causes of processing issues and financial leakage.
• Facilitate stakeholder workshops, discovery sessions, and executive presentations to align business and technology teams on findings and recommendations.
• Develop actionable remediation roadmaps, business cases, risk assessments, and transformation strategies that improve operational performance and reduce business risk.

Skills

QNXT experience

Pega workflows

Healthcare payer platforms

Stakeholder management

Executive presentations

Transformation strategies

Process mapping

Cross-functional collaboration

Education

Bachelor's degree or equivalent in Healthcare Administration, Information Systems, Business, or related field

Job description

About Cognizant Consulting:

Cognizant Consulting is more than Cognizant’s consulting practice—we’re a global community of 6,000+ experts dedicated to helping clients reimagine their business. Blending our deep industry and technology advisory capability, we create innovative business solutions for Fortune 500 clients. And now, we’re looking for our next colleague who’ll join us in shaping the future of business. Could it be you?

About the role:

As a Consulting Manager, Healthcare Business Transformation, you will make an impact by leading a comprehensive assessment of enterprise Long-Term Services and Supports (LTSS) operations, identifying opportunities to improve process efficiency, system interoperability, data integrity, and financial performance. You will be a valued member of the Healthcare Consulting team and work collaboratively with business stakeholders, LTSS operations teams, product owners, IT teams, architects, data analysts, finance leaders, and executive sponsors.

In this role, you will:

• Lead end-to-end assessment and documentation of LTSS business processes across authorization, claims, provider, member, and financial workflows.
• Analyze interactions between Pega, QNXT, and related healthcare platforms to identify process, integration, and data flow gaps.
• Evaluate authorization-to-claims transaction integrity, data mappings, and operational controls to identify root causes of processing issues and financial leakage.
• Facilitate stakeholder workshops, discovery sessions, and executive presentations to align business and technology teams on findings and recommendations.
• Develop actionable remediation roadmaps, business cases, risk assessments, and transformation strategies that improve operational performance and reduce business risk.

Work model:

We strive to provide flexibility wherever possible. Based on this role’s business requirements, this is a remote position open to qualified applicants in the United States. Regardless of your working arrangement, we are here to support a healthy work-life balance though our various wellbeing programs.

The working arrangements for this role are accurate as of the date of posting. This may change based on the project you’re engaged in, as well as business and client requirements. Rest assured; we will always be clear about role expectations.

What you need to have to be considered:

• Bachelor's degree or equivalent professional experience in Healthcare Administration, Information Systems, Business, or a related field.
• 8+ years of experience in healthcare consulting, business transformation, program management, or healthcare operations.
• Strong experience with QNXT and healthcare payer platforms, including claims, benefits, enrollments, and authorization workflows.
• Experience working with Pega-based healthcare workflows, care management, or authorization management processes.
• Proven expertise in healthcare process analysis, stakeholder management, business requirements, and current-state/future-state process mapping.
• Experience conducting system integration reviews, data lineage assessments, reconciliation analysis, and business impact evaluations.
• Strong communication and executive presentation skills with the ability to influence stakeholders across business and technology organizations.
• Experience creating executive-level deliverables, recommendations, remediation roadmaps, and transformation strategies.

These will help you stand out:

• Experience supporting Molina Healthcare or other Medicaid and LTSS-focused healthcare organizations.
• Knowledge of healthcare claims processing, financial workflows, payment integrity, and leakage analysis.
• Experience leading enterprise assessments involving interoperability, data governance, and technology modernization initiatives.
• Familiarity with healthcare regulatory requirements, managed care operations, and value-based care environments.
• Experience with business architecture, process mining, workflow optimization, or healthcare transformation consulting engagements.

Total Compensation:

The annual salary for this position is between $81,450 - $129,500 depending on experience and other qualifications of the successful candidate.

Benefits:

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off.
• 401(k) plan and contributions.
• Long-term/Short-term Disability.
• Paid Parental Leave.
• Employee Stock Purchase Plan

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.