Senior Managed Care Operations (MCO) Project Manager

Project Manager

Manages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts. The ideal candidate will be responsible for planning, executing, and delivering projects on time, within scope, and within budget. This role requires strong leadership, communication, and problem-solving skills to manage resources, mitigate risks, and ensure stakeholder satisfaction. Builds work breakdown structures, monitors task activities, and ensures state contract timelines are met. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors project teams through requirement solicitation, requirement documentation, and Sponsor approvals. Works as the liaison between the health plan and IT to ensure requirements are interpreted correctly and the development lifecycle timeline is being followed.

Communicates project status through weekly reporting, project status meetings, and leadership presentations. Manages the project RACI and RAID log, project plan, and other project management tools.

Skills :

Defines project scope, goals, and deliverables in collaboration with stakeholders.

Develops detailed project plans, schedules, and resource allocations.

Leads project teams, assigns tasks, and monitors progress.

Manages budgets, timelines, and project risks.

Communicates project status, issues, and milestones to stakeholders and leadership.

Ensures quality standards and compliance with company policies.

Facilitates meetings, workshops, and presentations.

Identifies and resolves project roadblocks and conflicts.

Strong analytical, organizational, and decision-making skills

Experience working with IT waterfall and agile system development lifecycle methodologies

Knowledge :

Experienced in working with claims and claim configuration teams to streamline adjudication and resolve claim processing issues

Familiar with payment integrity and other cost recovery processes

Direct PM experience in Managed Care Operations (claims, system configuration, provider data management preferred)

Demonstrated ability to solicit and formally document business and functional requirements

Accustomed to working with IT to ensure Health Plan requirements and timelines are met

Understands Medicaid and Medicare business scenarios and appreciates the member environments we serve

Exposure to all Managed Care industry functional departments

Job Qualifications :

Required Education : Bachelor's Degree or equivalent combination of education and experience

Required Experience : 5-7 years experience as a Health Insurance industry Project Management professional

Preferred Education : Graduate Degree or equivalent combination of education and experience

Preferred Experience : 7-9 years as Health Insurance industry Project Management professional

3-5 years in Managed Care with emphasis on Managed Care Operations

Preferred License, Certification, Association : PMP, CAPM, PMI-ACP, PMI-PBA or Six Sigma Black / Green Belt certification

Pay Range : $66,456 - $129,590 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.