FHIR/API → Middleware/Axway → .NET/SOAP backend → Prior Authorization Engine → Database/Messaging
They need to coordinate engineering and QA teams and understand where an integration issue may be occurring. They don't need hands-on expertise in ASP.NET MVC, WCF, NHibernate, RabbitMQ, Sybase, etc
Project Overview: This role supports a large healthcare technology program modernizing how insurance companies handle prior authorization (the approval process required before certain medical treatments or procedures). The work is driven by a federal regulatory mandate requiring health plans to move prior authorization to modern, API-based digital systems by 2027. The program spans nine different clinical service lines (such as radiology, cardiology, and musculoskeletal care) and covers integration work across multiple client health plans, with dozens of implementations in progress at once.
Architecture Overview: The solution is built across three integration layers, each owned by a different team:
- Front-end/API layer – handles FHIR-based REST API interactions with health plans, providers, and EMR systems, including authentication and request routing
- Middleware/routing layer – converts incoming FHIR requests into an internal canonical format and routes them via an enterprise integration platform (Axway) to the correct backend service
- Backend/business logic layer – this is where the role's team operates. It exposes REST/Web APIs (ASP.NET MVC 5, Web API 2) and legacy SOAP services (WCF) that hold the prior-authorization business logic for each clinical service line, and calls into the insurer's existing, long-standing prior authorization engine, which remains the system of record for actual approval decisions
Every request passes through all three layers end to end, so integration defects often surface only when the full path is tested together, not within a single layer.
Backend technology stack (varies somewhat by clinical service line):
- .NET Framework 4.7.2 / .NET 4.8, ASP.NET MVC 5, Web API 2, WCF
- StructureMap for dependency injection; business rules managed through a rules engine (InRule)
- Data layer: NHibernate and Dapper over Sybase (via ODBC), SQL Server, and MongoDB for document-style data (e.g., questionnaire responses)
- Asynchronous messaging via RabbitMQ and TIBCO EMS; Redis for caching
- CI/CD: Jenkins, Docker on Windows/IIS, Helm
- Test automation: Playwright
- One clinical service line runs on a different platform entirely (Java services with an Appian front end, backed by MongoDB), so the role requires comfort working across more than one technology stack, not deep expertise in all of them
Key Responsibilities:
- Identify and escalate delivery risks and dependencies early, particularly around data availability, environment issues, unclear requirements, and defects that span multiple systems or teams
- Coordinate with client-side product and business teams on testing readiness, open questions, and requirement changes
- Collect technical status from engineering and QA teams and turn it into clear, accurate reporting for leadership, distinguishing between different stages of readiness (development complete, integrated testing complete, client-ready)
- Track schedule commitments across many parallel workstreams and flag slippage or unresolved decisions before they become bigger problems
What we're really hiring for: This is primarily a client-facing delivery role. The technical environment is complex, but the gap we need filled is discipline and communication, not additional engineering depth. We need someone who will run a tight project plan, keep it current, and proactively surface status, risk, and asks to the client before they have to chase us for it.
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