Project Manager - Medicaid

Company :

Job Description :

JOB SUMMARY

The Project Manager is responsible for driving organization-wide project execution, audit readiness, and strategic compliance initiatives for complex health plan accreditation and regulatory programs. This role serves as the operational backbone for maintaining compliance with NCQA (Commercial, Medicare Advantage, Medicaid, CHIP, Health Equity, and Special Needs Plans), Medicaid state contracts, URAC, CMS, and state/federal regulations. Leveraging a strong clinical or legal background, the Project Manager bridges the gap between complex regulatory mandates (including Title VI/LEP, HIPAA, and delegation oversight) and cross-functional operational execution across Quality Management, Utilization Management, and Credentialing.

This role can be hybrid or remote - if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, TH.

ESSENTIAL RESPONSIBILITIES

• Works with business and technical organizations to drive out program strategy and approach. Organizes, plans, and maintains Program roadmap consisting of cross-functional activities/projects.
• Work with business and technical organizations to assemble project teams. Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program.
• Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives. Acquire understanding of the business objectives for an assigned area."
• Monitor, evaluate and report on Program status inclusive of scope, schedule, budget and alignment to Program and strategic goals. Direct corrective action as needed to maintain the viability of the Program.
• Develop and maintain positive customer relationships. Deliver presentations of project status to effectively communicate throughout the project lifecycle.
• Adhere to Highmark project management methods, project lifecycle methodologies, and audit requirements. Support and contribute to the improvement of project management methods and practices.
• Other duties as assigned or requested.

EDUCATION

Minimum

• High School Diploma/GED

Preferred

• Bachelor’s degree

EXPERIENCE

Minimum

• 1 - 3 years experience in a project manager role and/or in a project leadership role

Preferred

• Health Care Insurance industry business and operational knowledge
• Experience with an industry standard software development lifecycle

LICENSES/CERTIFICATIONS

Required

• None

Preferred

• PMP certification or equivalent training

SKILLS

• Experience with customer relationship management
• Presentation skills
• Negotiation skills
• Experience with conflict resolution
• Experience with Risk Mitigation Planning
• Team Building Skills
• Strong interpersonal skills
• Very good verbal and written communication skills
• Solid organizational and planning skills
• Solid leadership skills

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Hybrid or Remote - This role can be hybrid or remote - if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, TH.

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Occasionally

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

About Us

Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network.

Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services.

Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.