Program Manager II - Medicare/Marketplace Claims

Arizona Complete Health; Indiana (PA); Remote; USD 68,000 - 124,000; Full time

Job summary

An established industry player is seeking a Program Manager II to lead transformative initiatives in healthcare. This role focuses on planning, organizing, and overseeing programs to meet strategic objectives while driving collaboration across teams. With a strong emphasis on project management and data analysis, the ideal candidate will have expertise in Medicare and Marketplace programs. This position offers remote work flexibility, ensuring a balance between professional and personal life. Join a forward-thinking organization committed to improving community health and making a real difference for millions of members.

Benefits

Health Insurance

401K

Stock Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 3+ years of project management experience in healthcare preferred.
• Strong background in data analysis and healthcare operations.

Responsibilities

• Leverage data analysis skills to support decision-making and issue resolution.
• Drive process improvements and manage projects through their lifecycle.

Skills

Project Management

Data Analysis

Healthcare Operations

Collaboration

Process Improvement

Education

Bachelor's Degree

Tools

SQL

Microsoft Project

Smartsheet

Microsoft Office Suite

Microsoft Teams

SharePoint

Job description

4 days ago Be among the first 25 applicants

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose

This Program Manager II will support AZ Complete Health by planning, organizing, monitoring, and overseeing programs using cross-functional teams to meet business needs and strategic objectives.

The ideal candidate will have a strong background in project management, data analysis, and healthcare operations (especially claims and configuration), with expertise in Medicare and Marketplace programs. Skills in driving collaboration, analyzing complex data, and process improvement are essential.

Responsibilities

1. Leverage data analysis skills to run queries, pull claims data, and identify trends to support decision-making and issue resolution.
2. Apply knowledge of billing and reimbursement rules for Medicare and Marketplace to support claims analysis and ensure compliance.
3. Serve as the primary liaison between Provider Engagement, Internal Medicare Operations/Value Based team, and Shared Services for effective collaboration.
4. Ensure Medicare and Marketplace deliverables meet quality and turnaround standards.
5. Drive process improvements by identifying gaps and collaborating on changes.
6. Support claims issue resolution by identifying trends and troubleshooting escalated concerns.
7. Support initiatives that promote quality, safety, and cost of care.
8. Gather requirements, create plans, manage resources, and facilitate project execution.
9. Use industry-standard tools to oversee programs according to procedures.
10. Maintain detailed documentation including meeting minutes, issues, and risk plans.
11. Create and monitor department deliverables for quality standards.
12. Communicate program status to management and stakeholders.
13. Identify resources, resolve issues, and mitigate risks.
14. Coordinate cross-functional meetings to meet stakeholder expectations.
15. Manage projects through their full lifecycle.
16. Provide leadership and communicate project status effectively.
17. Negotiate with stakeholders to secure resources and resolve issues.
18. Perform other duties as assigned and ensure policy compliance.

Education/Experience

• Bachelor's degree or equivalent experience.
• 3+ years of project management experience.
• Healthcare experience preferred.

Technical Skills

• Proficiency in SQL or similar query languages for data analysis.
• Experience with project management tools like Microsoft Project or Smartsheet.
• Strong skills in Microsoft Office Suite, especially Excel, PowerPoint, and Word.
• Familiarity with collaboration tools like Microsoft Teams and SharePoint.

This role offers remote work flexibility within the Continental US, with an ideal schedule of 8am - 5pm MST.

Pay range: $68,700 - $123,700 annually.

Benefits include health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work arrangements.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.