Program Manager Project

SHARAD RAWALE

740-***-**** **************@*****.*** Powell, Ohio US Citizen LinkedIn

CAREER SUMMARY

Highly accomplished Project Manager with 20+ years of experience leading complex healthcare and IT initiatives, demonstrating expertise in CMS mandates (including State Directed Payment), EHR integration

(EPIC, Cerner, Healthiva), healthcare analytics, and data exchange (FHIR, HL7). Proven ability to manage multi-million-dollar budgets, cross-functional teams, and vendor relationships while ensuring regulatory compliance (HIPAA). Adept at leveraging Agile and Waterfall methodologies to drive successful project delivery, improve operational efficiency, and enhance patient outcomes within diverse healthcare settings, including Medicaid/Medicare, payer organizations, and research institutions. CORE COMPETENCIES/SKILLS

● Project Management & Healthcare Expertise: Project Management Vendor Management CMS Mandate HIPAA Compliance Organizational Change Management Agile & Waterfall Methodologies

Issue - Risk Management Quality Improvement Matrix environment Team Collaboration Business Process Development ROI Analysis EMR Integration (Cerner, EPIC, EPIC PP, Healthiva, Medent) Healthcare Analytics Health Information Exchange (HIE) Clinical Data Architecture Healthcare Claim Processing Population Health Analytics Case Management CDA RCM M&A

● Technical & Data Skills: FHIR APIs HL7 ALM SDLC DevOps Engineering Data Governance Data Lake Data Migration & Visualization SPRINT AWS MS Azure Office 365 Integration Infrastructure Management SEO SSO TriZetto Facets Workday PBM A1C Data Management Vaccination Data Management Java, J2EE, HTML PHP, CSS, & JavaScript WORK EXPERIENCE

Project Manager Dec 2024 - Present

CareFirst - Blue Cross Blue Shield of Maryland

Trizetto Facets Data Consolidation & Migration Medicaid/Medicare Systems

• Leading critical phases of CareFirst’s $20M+ enterprise-wide data consolidation initiative, focused on migrating legacy Medicaid and Medicare complete Claims, Enrollment, Ready adjudicate, Pharmacy, Dental, Vision, Providers data into the Trizetto Facets platform.

• Managing the Integrated Project Plan (IPP), coordinating cross-functional teams and vendor partners to track milestones, align scope, and ensure on-time delivery.

• Overseeing data migration execution while ensuring data integrity, regulatory compliance, and financial accountability for the CMS mandate and compliance.

• Driving business readiness, including infrastructure alignment, end-to-end testing, user training, and go-live planning.

• Maintaining comprehensive project documentation and facilitating stakeholder communication to ensure transparency and audit readiness.

• Validating system performance and ensuring operational readiness, adherence to SLAs, and long-term platform stability.

Project Manager Feb 2024 – Nov 2024

Lisinski Law Firm, Powell, Ohio 43065

Workday Human Capital Management (HCM and Finance)

● Led the end-to-end implementation of the Workday HCM, Finance, and Payroll project, focusing on workplace modules to streamline HR, Payroll, and Finance operations.

● Served as the primary liaison between the Workday implementation team, Lisinski business partners, and vendors to drive a successful digital modernization initiative.

● Managed Single Sign-On (SSO) access, user identity, and the integration of bidirectional SFTP file transfer for secure handling of sensitive data used in the creation of Workbooks.

● Oversaw project planning, deliverables, timelines, and risk management to ensure the seamless execution of the Workday HCM, Payroll, Finance, and ADP solution, utilized project management tools such as Smartsheets and ASANA.

Project Manager Jan 2023 - Feb 2024

Florida Blue, Jacksonville, FL

● Led projects under the Clinical Data Acquisition (CDA) CMS mandate, focusing on the real- time retrieval of Medicare and Medicaid claims, clinical data exchange, and integration of diverse data sources using FHIR and HL7 EDI/API in Agile SPRINT. SHARAD RAWALE 740-***-**** **************@*****.***

● Successfully integrated healthcare claims data into a data lake and data mapping for downstream distribution.

● Managed Health Information Technology and payer portal project, effectively addressing internal and external dependencies while collaborating with multiple teams. Maintained clear communication with VP and C-level leadership regarding project status.

● Facilitated technical sessions with Data and Solution Architects to strategize and execute data migration and API connectivity, ensuring alignment with project goals.

● Led cross-functional teams to facilitate the complete product development lifecycle from concept to implementation.

● Managed the project using ServiceNow, vendor relationships, organizational change management, and financial oversight.

● Collaborated with Availity vendors, IT staff, and business sponsors to design effective project solutions, providing regular status updates and addressing risks to ensure stakeholder alignment and transparency.

● As a project manager for care case management, I led projects to ensure timely, on-budget delivery. I collaborated with cross-functional teams to develop and execute project plans, managed stakeholder communication, and ensured regulatory compliance.

● I also focused on process improvements, monitored KPIs, and provided leadership to the case management team while managing vendor relationships and ensuring high service standards to improve patient outcomes.

Project Manager June 2021 – Dec 2022

Anthem Inc - Remote

Project-1 – EPIC Integration/ Clinical Data Acquisition

● Managed end-to-end projects for Clinical Data Acquisition (CDA), Electronic Medical Records

(EMR), and Real-Time Retrieval (RTR) of ADT data (HL7) from hospitals collaborating with Epic, setting up EPIC sandbox, Cerner, and Medent teams to ensure data validation, HIE, analytics, and quality outcomes.

● Facilitated the integration of Social Determinants of Health (SDOH)-related data enhancing decision- making for care plans, Medicaid System Design, HEDIS ratings, member outreach, and population health analytics.

● Oversaw provider portal enhancements for better outcomes, onboarding, project scope, SOW management, and timelines for CDA and ADT integration, maintaining effective communication with internal, external technical teams.

● Managed clinical data acquisition projects for EPIC, EPIC PP, Cerner, Medent EHR in HL7, and FHIR APIs.

● Interacted with technical team and downstream users pulling claims data and utilization for adjudication, medical data, vaccinations records, and analytics in alignment with Medicare/Medicaid claims data and clinical data.

Project-2 - Digital Experience

● Led project management for Digital Experience enhancement including provider portal, member portal, micro websites adhering to formal project management methods.

● Managed data governance and code release approvals across all projects, ensuring streamlined processes for system development and release management. Managed App enhancements and testing activities.

● Cultivated strong client, customer, and vendor relationships, consistently delivering on service expectations and project outcomes.

Delivery Lead Jan 2020 – May 2021

BlueCross BlueShield of Michigan

Project-1: Center for Medicare and Medicaid Services (CMS) Mandate - Interoperability and Patient Access

● Managed a federal project with a budget over $6 million to ensure compliance with CMS regulations for the Interoperability Patient Access mandate for Medicare members, utilizing FHIR APIs for data exchange.

● Collaborated with cross-functional teams to implement technical solutions that improved patient access to health information while conducting risk assessments and adhering to project timelines and budgets.

● Led the RFP preparation, vendor selection, SOW management, financial reporting, data security, data mapping, EMR integration, PBM integration, HIE, and Agile development using JIRA, Planview, SHARAD RAWALE 740-***-**** **************@*****.*** and ServiceNow for project delivery for development using Agile SPRINT, and issue tracking to ticket management in JIRA.

● Medicare members identity was authenticated and managed using OKTA for the API connectivity and Real Time Data (RTR) retrieval, authentication for business operation readiness.

● Complete CMS compliance mandate for Medicare members Medical, RX, Dental, and Vision claims, provider directory, and clinical data in FHIR format was provided to third party app users securing Medicare members data, and identity with e-PHI compliance

● Conducted technical sessions with internal teams and vendors to define project metrics and parameters.

● Managed change control, project finances, including timing implications, key payment dates, and progress reports to VP/ C- level Leadership.

Project-2: Palliative care and Group Insurance Data Exchange

• Managed multifaceted project involving multiple departments, PBM, Medicaid/Medicare Implementation, vendors, and stakeholders, ensuring on-time and within-budget delivery for Health Information Management (HIM),

• Oversaw the complete interface agreements, vendor onboarding, data transfer using SFTP channel, claim management for group insurance vendors, palliative care data exchange to achieve better health outcomes and member engagement.

Project Manager

BlueCross BlueShield of Tennessee July 2018 - Dec 2019

• Medicaid BHCC Project Manager: Led a large-scale Tennessee Medicaid (ODM) mandate project, streamlining behavioral healthcare for Medicaid members by implementing Prior Authorization, ODM-compliant billing.

• Medicaid PBM integration, EDI, CMS file processing, and claims processing. Improved care quality via Population Health Analytics and CC-BHCC measure tracking.

• Medicaid Population Health Analytics Lead: Oversaw data warehouse projects for Tennessee Medicaid clinical quality improvement.

• Transformed complex Medicaid data (claims, PBM, CMS) into actionable Tableau dashboards for BI and population health analytics, supporting BHCC, ADT monitoring, member outreach, claim management, and HEDIS improvement. Integrated SVI/SDOH data to enhance Medicaid member outcomes.

Project Manager Jan 2013 – June 2018

Healthiva, Mansfield, OH

Project 1: Healthiva EMR Development

• EHR Software Development Lead: Oversaw end-to-end development of EHR software (including billing) on Azure using SDLC, Java, JavaScript, HTML, ServiceNow, and DevOps. Gathered requirements, researched vendors (compared to EPIC, Cerner, Medent), and managed resources/budget, reporting to the CEO.

• EHR Product Innovation: Led development of EHR features for opioid addiction, pain management, Suboxone clinics, RCM, and healthcare claims data for the Healthiva product

(focused on SMBs). Collaborated with physicians in Agile Sprints to ensure user satisfaction and quality outcomes.

• Medicaid & Claims Management: Managed integration of Twilio SMS and TriZetto® QNXT- based Healthcare Claims Processing for Medicaid. Oversaw complete claim adjudication for provider/payer portals and digital content.

• Security & Integration: Implemented identity management (SSO, OKTA, tokenization), integrated Office 365/Active Directory, and managed tenant environments for Healthiva portals, ensuring security and compliance (access logs, audits).

• Merger & Data Integration: Led the merger of an acquired company, managing data integration to MS Azure, Health Plan compliance, HR/financial tracking in Workday, and infrastructure/asset consolidation, contributing to profitability.

• Data Analytics & Reporting: Integrated Medicaid/Medicare member data and managed the development of Power BI dashboards for reporting and analysis.

• EHR App Development & Training: Managed full lifecycle of the Healthiva EHR App, including RFP/SOW for vendors. Developed and delivered end-user and patient access training materials. SHARAD RAWALE 740-***-**** **************@*****.*** IT Project Manager Apr 2010 – Dec 2012

Ohio PTECH, Dublin, OH

• Analyzed business requirements, software specifications, work assignments, and managed project and the team for website development, digital development, and file server management.

• Managed complex web design projects with a hybrid onshore-offshore delivery model, utilizing technologies such as Java, HTML, CSS, WordPress, PHP, JavaScript and MySQL. Managed App development projects.

• Demonstrated expertise in change management, project and time management, organizational communication, team facilitation, and negotiation skills. Project Manager Sep 2001 – Mar 2010

Wexner Medical Center, The Ohio State University, Columbus, OH

• Clinical Trial Management: Spearheaded pre-clinical and Phase 1/2 clinical trials for a breast cancer vaccine program funded by NIH and other sponsors, managing funding, budgets, and 10+ resources. Secured funding and led cross-functional teams and vendors for new drug molecule trials.

• Clinical Operations & Collaboration: Collaborated with clinical staff and doctors at James Cancer Hospital for seamless Phase 2 breast cancer vaccine trial implementation, resolving complex issues.

• Change Management & Training: Managed organizational change for scope/schedule adjustments. Designed and implemented training for EHR, CTMS, and clinical trials, including regulatory/compliance. Managed lab infrastructure and compliance training.

• EHR/CTMS Expertise: Conducted end-user training for EPIC, legacy EHR systems, and CTMS for clinical trial management.

• Grant Management & Publications: Contributed to grant proposals and managed multi-million- dollar budgets from NIH and industry. Managed end-to-end Phase 1/2 vaccine trials using CTMS, data analysis/modeling, and EPIC for patient scheduling, data analytics, resulting in scientific publications.

TECHNICAL SKILLS

● Project Management: MS Project, Smartsheet, SharePoint, Planview, ASANA, JIRA, Waterfall, and Agile

● BI Tools: Tableau & Power BI

● Healthcare Data Exchange: FHIR APIs, HL7, & HIPAA

● OS & Office Tools: Linux, Windows, MS Office, Office 365, & VISIO

● Cloud Services: Microsoft Azure, AWS Cloud, Workday, & ServiceNow

● Electronic Medical Record (EMR): EPIC, EPIC-PP, CERNER, MEDENT, & HEALTHIVA EDUCATION AND PROFESSIONAL DEVELOPMENT

● PMI-ACP Certification - In progress

● Microsoft Azure Fundamentals – Course AZ900T00 – in Progress

● HIPAA Certification – American Health Training (AHT) 2024

● Introduction to Artificial Intelligence - LinkedIn Learning, 2024

● Project Management: Healthcare Projects - LinkedIn Learning, 2024

● PMI Agile Certified Practitioner (PMI-ACP) ®- LinkedIn Learning, 2023

● PhD – Peptide and Protein Engineering- Indian Institute of Technology (IITB), Bombay, India

● M.Sc. Chemistry, India

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