About Alaffia & Our Mission

Each year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, we’re committed to changing that paradigm. We’ve assembled a team of clinicians, AI engineers, and product experts to build advanced AI solutions that will directly bend the cost curve for all patients across the healthcare ecosystem. Collectively, we’re building best-in-class AI software to provide our customers with co-pilot tools, AI agents, and other cutting-edge solutions to reduce administrative burden and reduce healthcare costs.

We’re a high-growth, venture-backed startup based in NYC and are actively scaling our company.

About the Role

As a Project Manager for Payment Integrity and Utilization Management, you will lead high-impact SaaS and services implementations that help health plans reduce improper payments, optimize resource use, and accelerate ROI. This role offers the opportunity to drive measurable client success by combining deep healthcare domain expertise with proven project leadership in a fast-paced, collaborative environment.

What You'll Be Doing

• Project Management: Leading end-to-end implementation projects for Payment Integrity and Utilization Manager offerings, including scoping client requirements, configuring systems, and integrating existing workflows to optimize processing, reduce waste, and enhance compliance.
• Cross-Functional Collaboration: Partner with our Engineering, Product, and Claims teams to develop detailed project plans, timelines, and budgets, while performing risk assessments to minimize disruptions and ensure on-time delivery.
• Accelerating Client Outcomes: Coordinating the execution of Payment Integrity and Utilization Management initiatives and strategies to increase speed to value, client satisfaction, and cost-effectiveness.
• Client Training: Facilitating client training sessions, user adoption programs, and knowledge transfer to ensure smooth transitions, including hands-on support for data migration, system testing, and go-live activities.
• Driving Project Success: Monitoring project progress, reporting on key metrics (e.g., ROI, efficiency gains), and resolving issues through proactive problem-solving and escalation when needed.
• Championing Quality and Compliance: Ensuring all implementations adhere to healthcare regulations (e.g., HIPAA, CMS guidelines) and align with best practices, while driving continuous improvement based on client feedback and performance data.

What We're Looking For

• Certifications & Training: Project Management Professional (PMP) certification, Lean Six Sigma (Green Belt or higher), or other relevant professional training in project management methodologies and process improvement (e.g., PRINCE2, Agile/Scrum) is a strong plus.
• Health Plan Expertise: Familiarity with payer systems, health plan workflows, payment integrity, and coding methodologies (e.g., MS DRG, APR DRG).
• Proven Project Management Excellence: 5+ years of experience in project management, with at least 3 years focused on SaaS and services implementations in healthcare, ideally involving Utilization Management, Payment Integrity, or claim management services.
• Domain Knowledge: Deep knowledge of utilization management processes (e.g., authorization reviews, resource optimization) and payment integrity strategies (e.g., fraud detection, clinical validation, claims auditing), with familiarity in healthcare payer or provider settings
• Stakeholder Communication: Excellent communication and interpersonal skills, both written and verbal, to manage stakeholder expectations, facilitate cross-team collaboration, and present complex concepts clearly.
• Technical Acumen: Proficiency in project management methodologies (e.g., Waterfall, Agile) and tools such as Microsoft Project, Jira, or Asana; experience with healthcare-specific software (e.g., VMS, RPO systems) is highly desirable.
• Analytical Mindset: Strong analytical skills for data-driven decision-making, including the ability to interpret claims data, identify inefficiencies, and quantify ROI for clients.

Our Culture

Alaffia was born out of our founders’ personal connection to the inefficiency of the U.S. healthcare system. We are deeply mission-driven, with an abiding belief that technology can help create a better future for everyone — and we’re looking for others who share our passion for change to join the team.

What Else Do you get?

• Competitive compensation package
• Medical, Dental and Vision benefits
• Flexible, paid vacation
• Work in a flat organizational structure — direct access to Leadership