Project Manager, Medical Policy Processes

Evolent; United States; On-site; USD 61,200 - 74,800; Full time

Benefits offered by this job

Health insurance

Comprehensive benefits

Job summary

Evolent is seeking a Project Manager for the Medical Policy team to support timely delivery of high-quality clinical guidelines. You will work with Medical Policy, Clinical Operations, Medical Leadership, IT, Provider Relations and other groups to ensure accurate publication and ongoing process improvement.

Responsibilities include managing day-to-day PM activities, publishing guidelines, maintaining data sources, and producing dashboards.

Qualifications

• Bachelor's degree plus 2+ years' project management experience in a medium to large corporation.
• High School or Associate’s degree with a minimum of 5 years of project management experience within the past 8 years.
• PMI Certification (any option)
• Lean Six Sigma Black Belt or Green Belt
• Knowledge of project management and process improvement practices
• Basic knowledge of health care management (CPT Codes, Medicare/Medicaid)
• Strong facilitation and interpersonal skills for cross-functional teams
• Ability to resolve/elevate issues promptly
• Communicate difficult/sensitive information tactfully
• Proven ability to plan, organize, schedule, and monitor project activities
• Strong working knowledge of Microsoft Product Suite

Responsibilities

• Support team responsibilities and project management activities as assigned
• Manage day-to-day operational aspects of Medical Policy team processes
• Support publication of Evolent Clinical Guidelines, Health Plan Specific Guidelines, and Legislative/Regulatory Guidelines
• Maintain source of truth information related to clinical guidelines application for utilization review requests
• Support and maintain information critical to accurate guideline publication
• Prepare reports and/or dashboards to represent project activity and status
• Apply project management methodology and enforce project standards using approved toolkit templates

Skills

Project management

Cross-functional collaboration

Facilitation

Communication skills

MS Office

Education

Bachelor's degree + 2+ years PM

High School/Associate +5 years PM

PMI Certification

Lean Six Sigma Green/Black Belt

Tools

Microsoft Office Suite

Job description

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

As a Project Manager on the Medical Policy team, you will work closely with Medical Policy teammates and other key stakeholder business groups to provide exceptional support of timely and accurate delivery of high-quality Evolent clinical guidelines. Our team values collaboration, continuous learning, ongoing identification of efficiencies and process improvement, and a customer‑centric approach, ensuring that every team member contributes to providing the best clinical guideline product.

Collaboration Opportunities:

The Project Manager will partner most closely with Medical Policy teammates and collaborate with Clinical Operations, Medical Leadership, IT, Provider Relations, and other business groups.

What You Will Be Doing:

• Support team responsibilities and project management activities as assigned
• Manage day‑to‑day operational aspects of Medical Policy team processes
• Support publication of Evolent Clinical Guidelines, Health Plan Specific Guidelines, and Legislative/Regulatory Guidelines
• Maintain source of truth information related to clinical guidelines application for utilization review requests
• Support and maintain information critical to accurate guideline publication
• Prepare reports and/or dashboards to represent project activity and status
• Apply project management methodology and enforce project standards using approved toolkit templates

Qualifications (Required and Preferred):

• Bachelor's degree plus 2+ years' project management or job‑related experience with a medium to large‑scale corporation
• High School or Associate’s degree with a minimum of 5 years of project management or job‑related experience within the past 8 years
• Project Management Institute Certification (multiple certification options)
• Lean Six Sigma Black Belt or Green Belt
• Knowledge of project management and process improvement practices and methodologies
• Basic knowledge of health care management (CPT Codes, Medicare/Medicaid)
• Strong facilitation and interpersonal skills with the ability to work effectively with cross‑functional teams
• Ability to resolve and/or elevate issues in a timely fashion
• Understand how to communicate difficult/sensitive information tactfully
• Proven ability to plan, organize, schedule, direct, control, and monitor project activities
• Strong working knowledge of Microsoft Product Suite

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in‑person I‑9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

If you need reasonable accommodation to access the information provided on this website, please contact [e-mail] for further assistance.

The expected base salary/wage range for this position is $68,000. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.