Project Manager Clinical Operations

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.

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.

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