Project Manager Clinical Operations

Healthfirst; United States; Remote; USD 86,000 - 129,000; Full time

Job summary

An established industry player is seeking a dedicated Project Manager to lead clinical operations projects and drive process improvements. This role involves managing a portfolio of projects, conducting complex data analytics to identify opportunities for improvement, and ensuring compliance with quality and budgetary targets. The ideal candidate will possess strong project management skills and a background in healthcare, particularly in Medicare and Medicaid environments. Join a forward-thinking organization that values innovation and quality outcomes, and make a significant impact in the healthcare sector.

Benefits

Medical Coverage

Dental Coverage

Vision Coverage

401k Contributions

Life Insurance

Incentive Programs

Recognition Programs

Qualifications

• Bachelor's degree required; experience in Medicare/Medicaid managed care preferred.
• Strong project management skills with a focus on quality outcomes.

Responsibilities

• Manage clinical operations projects from development to implementation.
• Perform complex analytics to monitor care management efforts and compliance.

Skills

Project Management

Data Analytics

Stakeholder Management

Process Improvement

Presentation Skills

Quality Outcomes

Utilization Management

Education

Bachelor's Degree

Master's Degree

Tools

Microsoft PowerPoint

Microsoft Excel

Job description

The Project Manager will be responsible for reporting development, maintenance and analysis of clinical operations data or the development of new process/ existing process improvement efforts resulting from data analytics, current state assessments or system/strategic changes. The position involves reporting development and monitoring, complex analytics to identify risk and opportunity areas, project management, program oversight to ensure that the Clinical Operations team is meeting its compliance, quality, operational, and budgetary targets. The Project Manager serves as a point person for clinical operational leads to support reporting and process improvement and ensure standardization and accuracy across the organization. The PM also supports the SVP in assessing the health of the organization, prioritizing improvement and new initiative efforts and assessing the success utilizing rigorous methodologies.

• Manages portfolio of select Clinical Operations projects; from workplan development to stakeholder management to change management, implementation and metrics development and measurement.
• Develops and runs reports and performs complex analytics to monitor and provide succinct summaries with actionable steps on care and utilization management efforts, medical cost savings and regulatory compliance of implemented projects under the direction of the XXX and in collaboration with Finance, CIA, Compliance and other parties as necessary.
• Performs current state assessments to identify root cause issues and identifies data-driven opportunities for improvement throughout the organization.
• Develops comprehensive process improvement and implementation plans and performs impact analysis to identify barriers or risks to successful implementation: Leads meaningful change and process effectiveness through continuous focus and improvement.
• Leads implementation and ongoing meetings with staff to ensure stakeholder alignment.
• Manages project execution, resource deployment and overall coordination efforts to ensure projects are completed on schedule and to budget.
• Establishes and monitors audit process to ensure adherence to specific project goals.
• Ensures that all efforts have solid reporting plans in place and utilizes those reports to measure the success of the operation and new initiatives.
• Prepares presentations and delivers oversight reports. Reports status to leadership, and escalates changes, issues, risks for resolution as needed.
• Consistently monitors performance of existing vendors and process improvements.
• Additional duties as assigned.

Minimum Requirements

• Bachelor's Degree from an accredited institution.
• Previous history of working in a Medicare and Medicaid managed care environment with a focus on quality outcomes in utilization management.
• Experience in organizing and managing multiple detailed projects within expected timeframes.
• Experience creating presentations using Microsoft PowerPoint.
• Experience presenting ideas to cross functional employees within an organization.
• Experience using Microsoft Excel to create, edit and manipulate data.

Preferred Qualifications

• Master’s degree from an accredited institution.
• Certifications such as PMP, Six Sigma Green Belt or LEAN.
• Experience working in a Scaled Agile Framework (SAFe) environment.
• Experience in managing or working on projects across multiple departments using an SDLC methodology and Agile/Scrum methodology.
• Knowledge and/or experience with multiple Agile techniques: User Stories, ATDD, TDD, Continuous Integration, Continuous Testing, Pair Programming, Automated Testing.
• Experience with application and/or systems implementations or upgrades.
• Industry work experience in healthcare such as hospital, managed or long-term care, insurance, government or other healthcare agency.
• Experience working with one or more Medicaid managed care plan products, such as Family Health Plus (FHP), Eastern Benefits System (EBS) and/or Federal Employee Program (FEP).
• Knowledgeable of Department of Health (DOH) and Center for Medicare & Medicaid Services (CMS) regulations.
• Experience leading teams focusing on professional growth and development and organizational goals.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212-519-1798. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775

• All Other Locations (within approved locations): $86,500 - $128,690

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.