Project Manager - Medicaid

Company :
Highmark Inc. Job Description :

The Project Manager is responsible for driving organization-wide project execution, audit readiness, and strategic compliance initiatives for complex health plan accreditation and regulatory programs. This role serves as the operational backbone for maintaining compliance with NCQA (Commercial, Medicare Advantage, Medicaid, CHIP, Health Equity, and Special Needs Plans), Medicaid state contracts, URAC, CMS, and state/federal regulations. Leveraging a strong clinical or legal background, the Project Manager bridges the gap between complex regulatory mandates (including Title VI/LEP, HIPAA, and delegation oversight) and cross-functional operational execution across Quality Management, Utilization Management, and Credentialing.

This role can be hybrid or remote - if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, TH.

Works with business and technical organizations to drive out program strategy and approach. Organizes, plans, and maintains Program roadmap consisting of cross-functional activities/projects. Work with business and technical organizations to assemble project teams. Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program. Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives.

Acquire understanding of the business objectives for an assigned area." Monitor, evaluate and report on Program status inclusive of scope, schedule, budget and alignment to Program and strategic goals. Direct corrective action as needed to maintain the viability of the Program. Develop and maintain positive customer relationships. Deliver presentations of project status to effectively communicate throughout the project lifecycle. Adhere to Highmark project management methods, project lifecycle methodologies, and audit requirements.

Support and contribute to the improvement of project management methods and practices. Other duties as assigned or requested.

Minimum High School Diploma/GED Preferred Bachelor's degree

Minimum 1 - 3 years experience in a project manager role and/or in a project leadership role Preferred Health Care Insurance industry business and operational knowledge Experience with an industry standard software development lifecycle

Required None Preferred PMP certification or equivalent training

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

Position Type Hybrid or Remote - This role can be hybrid or remote - if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, TH. Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally Disclaimer:
The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement:
This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's…