Risk Adjustment Project Manager I/II/III

company•City of Utica, NY

1d•$62,400 - $129,384

About The Position

Summary: Under the guidance of Risk Adjustment leadership, this position is responsible for delivering multiple concurrent Risk Adjustment Projects and Programs with quality, to plan, and within budget. The Risk Adjustment Project Manager is responsible for all aspects of the project from initiation to post-implementation monitoring and maintenance. This will include developing communications and presenting to internal and external audiences. Manages risk adjustment projects as assigned. In addition, the Project Manager will govern and provide oversight of assigned vendor partners within the Risk Adjustment Program Portfolio to ensure vendor performance meets contractual and Health Plan needs. Conducts operational process analysis and process improvement identification and recommendations and executes action plans. Responsible to fill one or more roles (simultaneously if needed) on Maintenance of Business (MOB) project teams (e.g., program manager, product manager, user experience lead). Essential Primary Responsibilities/Accountabilities: All Levels Plans, directs, and coordinates matrixed team(s) activities to manage and implement interrelated risk adjustment projects. Plans, schedules, monitors, and reports on activities related to Risk Adjustment projects and process improvement initiatives. Process improvement responsibilities include internal Risk Adjustment teams as well as process improvement for cross-divisional departments. Guides and mentors Implementation project management team and fosters positive attitudes among staff re quality and excellence of execution to ensure that delivered service meets agreed service levels. Creates the Risk Adjustment project work plans and is responsible for their execution. Acts independently to assess and monitor projects and vendor partners performance, including problem identification, developing potential solutions, implementing them and evaluating outcomes involving various staff as needed. Responsible for troubleshooting and using all resources to find needed answers. This includes assessing when to elevate issues and doing so as needed. Trains and mentors project team as to how to get project work done, how to use project tools and resources. Writes and speaks fluently on all aspects of work. Communicates effectively with vendor partners, providers, colleagues 2-3 levels up/down and across a range of disciplines, and all levels of management. Organizes and prioritizes tasks, proposed work assignments so that as to successfully complete projects in a timely manner. Manages multiple projects with competing deadlines to successful completion. Will act and serve as Project Manager, Product Manager, Program Manager, Test Lead and User Experience Lead (if needed simultaneously) within the Microsoft Framework Solutions Team Process Model. Responsible of the creation and deployment of monitoring reports of the assigned Risk Adjustment projects. Responsible for enhancing communication within and outside key Risk Adjustment priorities, project work, and other impact of Risk Adjustment work cross divisionally (may design and deploy newsletter and other communications vehicles). Meets with management, sponsors, and project teams to review project scope/progress and resolve project issues. Coaches and counsels members of cross-functional teams to accomplish projects, meet established schedules, or resolve technical/operational issues. Establishes appropriate metrics for measuring key project criteria. Selects and applies appropriate tools to accurately estimate and plan the work of teams or project groups within agreed policies. Produces work plans according to required standards. Works with colleagues to produce/recommend/develop long-term plans. Fosters a positive environment of continuous process improvement. Constantly exploring ways to increase efficiencies and productivity, reducing waste, and reducing costs. Monitors and reports on the progress of the resolution of high impact problems according to established standards. Handles those exceptions that have been referred from below relating to schedules, working methods, resources, staff matters, or technical difficulties. Passes decisions clearly outside scope upward, including proposed solutions whenever appropriate. Ensures contracted vendor partners are being managed using standard governance processes including quarterly business reviews, vendor scorecards, escalation process, etc. Executes and manages vendor performance corrective action plan. Conducts post project Lessons Learned sessions project team and vendor partner. Always acts professionally and encourages professional standards among staff. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II - performs these additional responsibilities: Acts as lead and as contact company-wide for Risk Adjustment projects. Responsible for answering questions regarding risk adjustment projects and education for project internally and externally. Represents Managers and Directors of supported areas in all pertaining to related projects, including decision-making responsibilities, attendance at cross-divisional and regional committees, meetings and workgroups. Determines, monitors, and reviews all project economics to include project costs, operational budgets, staffing requirements, project resources, and project risk. Identifies and assembles the appropriate blend of talent and additional resources to meet project needs and requirements. Formulates contingency plans to address schedule revisions, manpower adjustments, fund allocations, and work requirements. Ensures adherence to legally binding requirements and customer long-term strategic goals. Controls project requirements, scope, and change management issues. Level III - performs these additional responsibilities: Responsible for taking all necessary steps with procurement, accounts payable, risk adjustment controls to ensure validated payment to contracted vendor partners. Develops vendor performance metrics to monitor and evaluate vendor performance, making recommendations for additions and deletions of vendors as appropriate. Leads in the identification and selection of vendors by directing the RFP process, partners with Finance on the financial details of the contract and partners with Legal to ensure the corporation is protected by the contract. Additionally, ensures all vended processes and interfaces are compliant with our security requirements. Develops risk adjustment vendor contracts including all necessary service level agreements. Leads re-negotiation and/or termination activities related to vendor relationships.

Requirements

A relevant BS degree and and minimum of 2 years of Project Management experience
A minimum of 3 years demonstrated performance in a related area
Demonstrated leadership skills.
Demonstrated skills in developing and achieving project scope, costs, planning and meeting project deliverables.
Demonstrated skills in forming and fostering high performance, cross-functional teams.
Highly Effective communicator.
Demonstrated skills quality principles, especially root cause analysis and problem solving Demonstrated business and technical problem solving skills.
Very strong analytical and business process development skills.
Strong organizational and multi-tasking skills.
Demonstrated competence in staff leadership and project leadership tasks.
A relevant BS degree and a minimum of 3 years Project Manager experience
PMP/PMI Certification required
A relevant BS degree and a minimum of 5 years Project Management experience.
PMP/PMI Certification required

Nice To Haves

PMP/PMI Certification preferred
Lean Six Sigma experience desired
Expert knowledge of Health Plan Operations and/or Risk Adjustment Operations

Responsibilities

Plans, directs, and coordinates matrixed team(s) activities to manage and implement interrelated risk adjustment projects.
Plans, schedules, monitors, and reports on activities related to Risk Adjustment projects and process improvement initiatives.
Guides and mentors Implementation project management team and fosters positive attitudes among staff re quality and excellence of execution to ensure that delivered service meets agreed service levels.
Creates the Risk Adjustment project work plans and is responsible for their execution.
Acts independently to assess and monitor projects and vendor partners performance, including problem identification, developing potential solutions, implementing them and evaluating outcomes involving various staff as needed.
Trains and mentors project team as to how to get project work done, how to use project tools and resources.
Writes and speaks fluently on all aspects of work. Communicates effectively with vendor partners, providers, colleagues 2-3 levels up/down and across a range of disciplines, and all levels of management.
Organizes and prioritizes tasks, proposed work assignments so that as to successfully complete projects in a timely manner.
Manages multiple projects with competing deadlines to successful completion.
Will act and serve as Project Manager, Product Manager, Program Manager, Test Lead and User Experience Lead (if needed simultaneously) within the Microsoft Framework Solutions Team Process Model.
Responsible of the creation and deployment of monitoring reports of the assigned Risk Adjustment projects.
Responsible for enhancing communication within and outside key Risk Adjustment priorities, project work, and other impact of Risk Adjustment work cross divisionally (may design and deploy newsletter and other communications vehicles).
Meets with management, sponsors, and project teams to review project scope/progress and resolve project issues.
Coaches and counsels members of cross-functional teams to accomplish projects, meet established schedules, or resolve technical/operational issues.
Establishes appropriate metrics for measuring key project criteria.
Selects and applies appropriate tools to accurately estimate and plan the work of teams or project groups within agreed policies.
Produces work plans according to required standards.
Works with colleagues to produce/recommend/develop long-term plans.
Fosters a positive environment of continuous process improvement.
Monitors and reports on the progress of the resolution of high impact problems according to established standards.
Ensures contracted vendor partners are being managed using standard governance processes including quarterly business reviews, vendor scorecards, escalation process, etc.
Executes and manages vendor performance corrective action plan.
Conducts post project Lessons Learned sessions project team and vendor partner.
Always acts professionally and encourages professional standards among staff.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Acts as lead and as contact company-wide for Risk Adjustment projects.
Represents Managers and Directors of supported areas in all pertaining to related projects, including decision-making responsibilities, attendance at cross-divisional and regional committees, meetings and workgroups.
Determines, monitors, and reviews all project economics to include project costs, operational budgets, staffing requirements, project resources, and project risk.
Formulates contingency plans to address schedule revisions, manpower adjustments, fund allocations, and work requirements.
Responsible for taking all necessary steps with procurement, accounts payable, risk adjustment controls to ensure validated payment to contracted vendor partners.
Develops vendor performance metrics to monitor and evaluate vendor performance, making recommendations for additions and deletions of vendors as appropriate.
Leads in the identification and selection of vendors by directing the RFP process, partners with Finance on the financial details of the contract and partners with Legal to ensure the corporation is protected by the contract.
Develops risk adjustment vendor contracts including all necessary service level agreements.
Leads re-negotiation and/or termination activities related to vendor relationships.