HealthRules Payer Sr. Project Manager- Health Insurance

Overview

Remote With Possible Future Travel Full-time. Projé, Inc. is a woman-owned consulting firm providing advisory consulting services, project management, and analytical business resources in the health care industry. As a trusted advisor, Projé provides the knowledge, skills, and leadership to help clients achieve their goals. Projé offers a strong team-centered culture, focused on meeting project deliverables with excellence.

• Uses program and project management experience, training, and skills to run successful projects within a Health Insurance Organization, specifically a Health Rules Payer claims system Implementation/Migration.
• Proven Expertise in Health Rules Payer and the functional areas within a health insurance organization, including enrollment, billing, claims, finance, provider, benefits, and medical management (Guiding Care).
• Engages with multiple stakeholders at all levels of the organization, including executives, directors, managers, and individual contributors.
• Ensures that the business teams integrate their designs so that functional areas do not make design decisions in a silo and that any cross functional impacts are coordinated.
• Coordinates the global design with the vendor to ensure that business needs are viewed in whole rather than at a functional level only.
• Coordinates cross functional UAT and E2E testing needs and ensures that the end-to-end business processes are tested appropriately.
• Provides configuration expertise for Health Rules Payer, and on-the-job guidance and training for other project staff.
• Responsible for managing configuration alignment across areas to support a complete and cohesive solution.
• Ensures that configuration methodology is followed and documentation is maintained.
• Leads configuration change control processes.
• Provides strategic advice to the Program Delivery Team.
• Owns and manages the program Functional teams.
• Ensures that overall business needs are addressed as related to the scope.
• Ensures deliverables are on track and escalates any project-related issues.
• With Domain Functional Leads, ensures that issues and risks are managed and mitigated.
• Alerts Program Delivery Team of significant potential program risks and makes recommendations concerning risk mitigation, scope change, and other key issues.
• Participates in the Change Control process within the Functional Domain.
• Responsible for functional requirement traceability between requirements gathered, design documents, workflows, and the configuration workbook.
• Develops and manages a project schedule throughout the project life cycle, from initiation through post-implementation.
• Applies formal Change Management processes when substantive modifications affecting the project scope, timeline, or resources/budget are suggested or necessary.
• Ensures the project team provides high-quality and cost-effective analytical support services.
• Facilitates and/or leads process improvement discussions and ensures that current state, desired state, and gaps are well documented for the development of recommendations.
• Facilitates issue resolution through analysis and collaboration; develops and presents recommendations to leadership and negotiates to reach a resolution.
• Support post-implementation stabilization and project closure activities.

• Must have hands-on experience in the Health Rules Payer claims system and understand the configuration of that system.
• Prior experience with a Health Rules Payer and Guiding Care Implementation or conversion required.
• Proven success in multiple project implementations within a health insurance company in claims, billing, provider, enrollment, benefits, and medical management (Guiding Care), etc.
• Ability to manage functional leads and functional…