Senior Project Manager Medicaid Network Implementations Remote

Profile

Description

The Senior Project Manager, Medicaid Provider & Network Implementation (remote) is accountable for working with the Director, Provider & Network Implementation to assist with driving efficient management of end-to-end provider-related functions in new Medicaid market implementations. This position will translate network and provider strategies into tactical plans that can be executed on to ensure timely and successful new market launches. This position will direct the timelines, processes, provider data needs, and enterprise readiness to effectively implement network development strategies. Decisions are typically related supporting technical and operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves processes and performance. The Senior Project Manager, Medicaid Network Implementation requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

Key Responsibilities :


Oversee the provider value chain within Medicaid market implementations to ensure timely and accurate delivery of health plan operational functions, including network contracting, provider operations, value-based payment, and provider services areas.
Partner with cross functional and matrixed teams to drive key operational decisions, oversee implementation progress and milestones, and other project management functions.
Develop and maintain project plan
Manage the RAID log (Risk/Issues log for escalations)
Convene matrixed operational partners to solve for operational gaps/barriers. Solutioning may also include some product development responsibilities, such as developing timelines, process maps, and process flow diagrams in partnership with subject matter experts.
Lead provider and network implementation preparation, including identifying business owners and subject matter experts in contract shreds, identifying potential business or operational gaps and state nuances.
Participate in state meetings and share updates with key business and operational partners.
Support operational readiness preparation, as needed
Assist in creating the governance protocols to document and monitor processes, rules, requirements, metrics and performance, and standard operating procedures within division and among shared services partners where relevant.
Contribute to the implementation of network and provider related contract requirements and RFP commitments to ensure they are on time
Plan, organize, monitor, and oversee complex network implementations utilizing matrixed and cross functional teams to deliver defined requirements and meet company strategic objectives
Drive process improvements and operational gap closure to improve efficiencies of provider and network implementations
Identify and solve problems that impact the management and direction of the business

Build and maintain strong internal working relationships at all levels of the organization and across the Enterprise; leverage these relationships in helping to drive innovation and effective operations for Humana Medicaid


Required Qualifications


Bachelor's Degree or 5 years of Medicaid managed care, network contracting, network/provider operations, and/or provider relations experience
5 years of project management experience
Proven expertise in driving operational efficiencies and management of timelines and processes. Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results.
Passion for people development and demonstrated leadership success
Ability to identify, structure and solve business problems
Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team and internal business partners


Preferred Qualifications


PMP certification
Six Sigma certification


Additional Information

This position is open to working remote. MUST be willing to work east coast hours.

Work-At-Home Requirements


WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


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Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

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