Healthcare Project Manager
Role: Project Manager with Healthcare Claims Experience and PMP Certification Job Summary: Leads and contributes to projects focused on making estimated costs of healthcare services easily accessible and understandable to consumers. Projects include the introduction of new data and cost estimation approaches, digital services, and next generation technical infrastructure and processes as well as the management of existing capabilities. Provides project leadership and oversight and serves as the link between the information technology team and business strategy, ensuring that strong technical solutions meet the business goals of internal and Plan stakeholders and support a great healthcare consumer experience. Provides resources and guidance as needed to Commercial Markets Staff team. Develop and maintain effective working relationships to provide value-added services for customers. Role requires the ability to work independently and effectively with multiple customers of varying levels including Commercial Markets; Plan business and technical staff; Client staff; Vendors; Governing bodies; and external workgroups. Primary Job Functions: 40% of Time Provide business direction and subject matter expertise for new and enhanced cost transparency capabilities. Lead projects and components of larger, multiyear projects to develop and enhance healthcare service and treatment cost data, estimation methodologies, technical infrastructure, and digital delivery. This requires an understanding of healthcare claims, data analysis, cost estimation methodology, policies and processes for exchanging data among parties (Blue Plans, providers, vendors, consumers, etc.), and the technologies required. Responsible for the business oversight and end-to-end business and project delivery of IT projects. Provide essential input to business analysts on the 40% development of business use cases and requirements. Develop service design concepts, policy and technical operational components, and implementation plans. Work with business and technical teams to assure effective development, testing and implementation of capabilities according to software development lifecycle processes. 20% of Time Work with cost transparency analytics and operations team as well as analytics vendors and consultants to support, maintain and manage existing cost transparency capabilities. Collaborate and communicate with Plans through workgroups, webinars, conferences, memos, and routine daily communications to ensure excellent operations and customer service. Work with the team to facilitate operations, answer questions, educate, and resolve issues. 20% of Time Communicate to various audiences and facilitate discussions for solutioning, consensus building, and adoption. Facilitate Plan and internal workgroups to develop consensus on goals and processes. Obtain Plan input for business requirements and development issues. Interact with internal and Plan staff, building cooperative relationships. Create reports, manuals, charts, spreadsheets, program documentation, and presentation slides. Collaborate with communications staff to write and memos and announcements for dissemination to subject matter experts and stakeholders across all Blue Plans. Make presentations to internal and Plan audiences at meetings and Plan educational programs to facilitate implementation and adoption across the Client System. Ensure development of user documentation and training materials supporting end users (operational and system support). 10% of Time Work with the project manager(s) to manage scope, cost, schedule, risks, issues, and defects. Enforce the use of project controls and tools that ensure accurate status reporting, management of risks, issues, changes and defects as defined in the project management plan. Coordinate to review and evaluate the quality and adherence of documentation standards and practices including producing and managing formal artifacts. Collaborate with the project manager to provide progress reports to management on a regular basis as defined in the project dashboard. 10% of time Participate on cross-functional teams to support other initiatives impacting the Association and/or the Client System. Participate on external industry-based workgroups focused on issues related to healthcare cost transparency solutions. Education, Experience and Certification: Required: Bachelors Degree (Bachelor's degree in Computer Science, Information Systems, Business Administration, or other related field or equivalent work experience) Preferred: Masters Degree Required: Minimum 7 years related experience with demonstrated project management, team leadership, and group facilitation skills. Required: 5 years healthcare data experience with a minimum of 3 years working with healthcare claims data Preferred Certification: PMP Knowledge, Skills, and Abilities: Proficiency in Microsoft Office applications, including Excel and Access. Experience managing and querying large data sets Technology skills Project Lead skills Data Analytics skills in related discipline Organizational and time management skills Relationship/customer management skills Preferred Experience: Previous health insurance experience, top healthcare industry experience would be a huge plus Understanding of the healthcare industry and the information exchange between consumers, providers, clearinghouses, payers and employers Experience with APIs to enable data exchange Experience with clinical data Excellent written and verbal communications skills Strong relationship-building skills Demonstrated ability to make presentations to internal and external audiences Strong analytical skills with demonstrated ability to execute on work plans to manage projects. Experience with software development project management and project life-cycle methodologies Experience writing requirements/facilitating requirement-gathering sessions Knowledge of system design concepts, client - server architecture, relational database design, reporting and related disciplines preferred Understanding of Agile principles and methodologies Ability to formulate and define systems scope and objectives through research and due diligence Demonstrated ability to come up to speed quickly and balance multiple tasks Ability to coordinate teams of internal and external stakeholders through meetings and decision processes Digital experience Role Designation: Hybrid Work Environment: Work is generally performed in an office or remote setting. Physical Demands: Sedentary work (exerting up to 10 lbs. of force occasionally and involving sitting most of the time with occasional standing and walking)
