Project Manager - Medicaid
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 for 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 execution across Quality Management, Utilization Management, and Credentialing. The Project Manager works with business and technical organizations to develop program strategy, organize and maintain roadmaps, assemble project teams, and lead the development and maintenance of comprehensive program plans. In partnership with executive sponsors, business owners, and management, the role works to achieve program objectives and maintain alignment with business goals. It monitors and reports program scope, schedule, budget, and strategic alignment; directs corrective action when needed; builds customer relationships; and presents status throughout the project lifecycle. The role follows and contributes to improvements in Highmark project management methods, lifecycle methodologies, and audit practices. The position may be hybrid or remote. Employees living within 50 miles of an office are required to work onsite Tuesday, Wednesday, and Thursday. A physical work site is required. Travel from the office to various work sites is rare.
Requirements
- High school diploma or GED.
- 1–3 years of experience in a project manager role and/or project leadership role.
- 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.
Nice To Haves
- Bachelor’s degree.
- Health care 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 develop program strategy and approach.
- Organize, plan, and maintain a program roadmap of cross-functional activities and projects.
- Assemble project teams with business and technical organizations.
- 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 and understand business objectives.
- 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, lifecycle methodologies, and audit requirements.
- Support and contribute to improving project management methods and practices.
- Perform other duties as assigned or requested.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
