Senior Consultant - Healthcare Technology

BC sector health-Senior-Health Technology

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Job Description: Senior Healthcare Technology Consultant

Role Summary

The Senior Healthcare Technology Consultant provides expert guidance across payer and provider domains, supporting solution design, technology implementation, and strategic transformation initiatives. The role requires deep understanding of healthcare operations, regulatory requirements, and modern technology platforms such as Pega, Salesforce, and Epic. The consultant acts as a subject matter expert and collaborates closely with clients, delivery teams, and technical stakeholders to translate complex business needs into actionable, scalable solutions.

 

Key Responsibilities

• Provide deep healthcare domain expertise across payer and provider operations including claims, utilization management, care management, member/provider services, and clinical workflows.
• Advise clients on end-to-end workflows, regulatory requirements (HIPAA, CMS, Medicare/Medicaid), and leading industry best practices.
• Translate business needs and challenges into functional requirements, solution concepts, process flows, and technical enablers.
• Support solution design and delivery for technology platforms such as Salesforce Health Cloud, Pega Care Management/UM workflows, and Epic (scheduling, referrals, authorization, clinical modules).
• Partner with cross-functional teams to drive client engagements, system implementations, product configuration, testing, and rollout activities.
• Act as a subject matter expert across healthcare technology, contributing to roadmap development, capability modeling, and operational assessments.
• Facilitate SME sessions, discovery workshops, and client presentations to support strategic initiatives and solution alignment.
• Develop high-quality consulting deliverables including process documentation, capability models, journey maps, and recommendations reports.

 

Preferred Qualifications

• Experience working with health plans, PBMs, TPAs, provider organizations, or multi plan environments (Commercial, MA, Medicaid).
• Knowledge of key regulatory frameworks including HIPAA, CMS rules, Medicare/Medicaid processes, compliance workflows, and industry data standards.
• Exposure to healthcare platforms such as payer core systems, EHRs, care management tools, CRM solutions, or interoperability frameworks.
• (If applicable) Understanding of Pega Decisioning, Pega Care Management, or Pega Customer Service for Healthcare modules.
• Relevant professional certifications such as AHIP, Lean Six Sigma, PMP, or platform specific credentials.

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Experience Level

Senior Level