Project Manager - Medicaid

Highmark Health•Carolina, PA

23h

About The Position

The Project Manager drives organization-wide project execution, audit readiness, and strategic compliance initiatives for complex health plan accreditation and regulatory programs. The role supports compliance with NCQA programs (Commercial, Medicare Advantage, Medicaid, CHIP, Health Equity, and Special Needs Plans), Medicaid state contracts, URAC, CMS, and state and federal regulations. It bridges regulatory requirements—including Title VI/LEP, HIPAA, and delegation oversight—with cross-functional operations across Quality Management, Utilization Management, and Credentialing. The position works with business and technical organizations to set program strategy, maintain roadmaps and comprehensive plans, assemble project teams, and deliver program objectives in partnership with executive sponsors and business owners. It monitors program status, including scope, schedule, budget, and strategic alignment; directs corrective action; maintains customer relationships; communicates status through presentations; and follows and contributes to Highmark project management methods, lifecycle methodologies, and audit requirements. The role may be hybrid or remote. Employees who live within 50 miles of an office are required to work onsite three days a week, Tuesday through Thursday. The position requires compliance with company policies and applicable laws, including HIPAA and information security requirements. The listed base pay range is $68,400 to $105,900, with possible geographic differentials.

Requirements

Minimum of 1–3 years of experience in a project manager role and/or project leadership role.
High school diploma or GED.
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.
Ability to work onsite Tuesday, Wednesday, and Thursday if living within 50 miles of an office.

Nice To Haves

Bachelor’s degree.
Healthcare insurance industry business and operational knowledge.
Experience with an industry-standard software development lifecycle.
PMP certification or equivalent training.

Responsibilities

Work with business and technical organizations to define program strategy and approach.
Organize, plan, and maintain a program roadmap of cross-functional activities and projects.
Work with business and technical organizations to assemble project teams.
Lead project managers and program teams in developing and maintaining comprehensive plans for a defined program.
Work with the executive sponsor, business owner, and other management to achieve program objectives.
Develop an understanding of business objectives for the assigned area.
Monitor, evaluate, and report program status, including scope, schedule, budget, and alignment with program and strategic goals.
Direct corrective action as needed to maintain program viability.
Develop and maintain positive customer relationships.
Present project status and communicate effectively throughout the project lifecycle.
Adhere to Highmark project management methods, project lifecycle methodologies, and audit requirements.
Support and contribute to improvements in project management methods and practices.
Perform other duties as assigned or requested.
Comply with applicable laws and company policies, including HIPAA, data security requirements, and the Code of Business Conduct.