Sr. Medicare Project Manager

Overview

The DSNP Project Manager is responsible for coordinating activities related to the Dual Eligible Special Needs Plan (DSNP) lifecycle. This role ensures compliance with CMS requirements, timely execution of deliverables, and seamless collaboration across internal teams and external partners and will oversee strategic project planning and manage all aspects of AEP operational readiness including all impacted business functions. This position will effectively manage assigned projects, utilizing appropriate project management methodologies to drive the planning, implementation, and tracking of projects through all aspects of the project lifecycle and will be responsible for the planning, procurement, and execution of a project.

This position is a leadership role that provides coaching and guidance to less experienced project managers, has a higher level of education and/or experience, is expected to work autonomously, and exercises independent judgment.

• In collaboration with RAC, manages the CMS application process in alignment with CMS timelines.
• Works with Finance to coordinate bid preparation, ensuring accuracy and compliance with program requirements.
• Collaborates with RAC in the application submission and maintain documentation for audit readiness.
• Supports DSNP development, planning, product implementation, and monitors operational performance.
• Collaborates with cross-functional teams (Compliance, Provider Engagement, Enrollment, Claims, Customer Service, UM/CM, Sales, Marketing, Quality, Finance) to ensure readiness and adherence to CMS standards.
• Partners with the Marketing team to execute DSNP marketing strategies and ensures compliance with CMS marketing guidelines.
• Oversees production and distribution of , member letters, and other required communications.
• Develops and manages the DSNP AEP readiness plan, including timelines, deliverables, and risk mitigation strategies.
• Monitors CMS guidance and state regulations to maintain adherence throughout AEP activities.
• Tracks and reports readiness metrics to leadership, identifying gaps and implementing corrective actions.
• Facilitates training and readiness sessions for internal stakeholders.
• Serves as the primary point of contact for DSNP AEPNeill readiness inquiries and escalations.
• Identifies process improvement opportunities and implements best practices.
• Manages projects with low to high complexity precision and ambiguous interdepartmental communications.
• Identifies and manages project deliverables, risks, dependencies, communication, and critical path for all assigned projects.
• Develops and maintains project plans, project charters, and budget summaries
• Works with subject matter experts and department representatives to develop, streamline, and implement newly established processes.
• Responsible for successful hand-off of established processes and project deliverables to appropriate business owner(s).
• Ensures projects stay on track by effectively following-up with project stakeholders and subject matter experts on outstanding project deliverables.
• Works autonomously in managing day-to-day project execution.
• Uses independent judgement to estimate project resource needs, identify time and resource constraints, and develops/adjusts project plans accordingly.
• May supervise and provide guidance to staff as assigned.
• Develops business cases,

  Bachelor’s degree and at least five (5) years of relevant project management experience required. In lieu of a degree, a minimum of eight (8) years of relevant experience to include a minimum of five (5) years project management experience will be considered. Five (5) or more years of experience in Medicare Advantage or DSNP program management required. Strong knowledge of CMS regulations and AEP processes.
  
  Experience with health plan operations, Medi-Cal and member engagement strategies. Familiarity with data analytics and reporting tools. Experience managing multiple complex projects with teams of 10 or more. Experience in health plan environment preferred.

  Special Skills, Licenses and Certifications

  Strong communication skills, both verbal and written, to interpret and articulate project requirements…