Sr Project/Program Manager

Job Description

Oversees the Medicare Prescription Payment Plan (M3P), working closely with internal matrix partners and external vendors to ensure all aspects of the program are administered timely, accurately and in compliance with the Centers for Medicare and Medicaid Services (CMS) requirements. Ensures that future program enhancements are funded and implemented as required by CMS. Leads and manages the day-to-day operational and tactical aspects of multiple or enterprise scale projects, new initiatives and other ongoing business deliverables in accordance with business needs. Identifies, evaluates and resolves issues that conflict with project deliverables. Collaborates closely with project team members, business owners and sponsors to develop and successfully implement projects/programs. Assesses project risks, develops mitigation and contingency plans. Oversees project to ensure projects have required resources, meets milestones and are successfully implemented. Leads and coordinates matrix and/or cross-functional team.

What You'll Do

• Develops project plans and recommendations in support of Departmental/Company objectives and leads implementation; tracks and reports on the status of the project.  Must ascertain, categorize and manage projects in relation to corporate priorities.

• Negotiates for resources to staff projects effectively with appropriate skill sets, aligning skills to the needs of the project. 

• Delegates work as required and ensures a quality end product through close customer contact and assesses customer/client satisfaction through direct feedback/evaluation.

• Coordinates development and implementation of policies and procedures as well as development of compliance measurements.  Controls and monitors project effectiveness; updates project plans as necessary.  Ensures compliance with necessary audit requirements.

• Represents Blue Cross NC in meetings with external parties including consultants, vendors, and others and may include service delivery management of vendors.

• Assists with analysis and development of business processes to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met.

• Develops escalation process to channel issues and concerns to appropriate parties.

• Evaluates project risks, developing contingency plans and responding to change in risk as the project progresses.

• Develops effective business process improvement initiatives and communication plans.

• Performs analytic functions and coaches others in analytical production, technical and other areas.

• Proposes a variety of solutions to business issues/problems utilizing appropriate analysis tools (i.e., Cost/Benefit Analysis, Flowcharting, etc.).

• Documents and presents project management results through the development of criteria, issue analysis papers and reports; ensures that projects established objectives such as financial goals, where applicable and creates an evaluation plan to assess project performance in relation to stated goals.

• Develops and tracks budgets, operating plans and financial cost forecasts to support the objectives of the project.

• Provides indirect reports, if applicable, with well-defined expectations, ongoing feedback, coaching/ mentoring and/or training.

What You'll Bring (Hiring Requirements)

• Bachelor's degree or advanced degree (where required)

• 5 years of experience in related field

• In lieu of degree, 7 years of experience in related field

Nice to Have (Hiring Preferences)

• Strong knowledge of Medicare Part D regulations and CMS requirements for the M3P installment payment program

• Proven experience in cross-functional program management, working with PBMs, IT, customer service, legal, and finance teams

• Familiarity with pharmacy claims processing, benefit adjudication, and installment billing logic

• Skilled in developing member communications, including M3P notices and billing explanations

• Ability to collaborate with marketing to ensure clear and compliant messaging

• Proficient in data analysis and reporting to evaluate program performance and compliance

• Understanding of systems integration and collaboration with IT to ensure accurate data flow

• Strong risk management and issue resolution capabilities in a regulated environment

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets,  licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. 

*Based on annual corporate goal achievement and individual performance.
 

$75,900.00 - $136,600.00

Salary : $75,900 - $136,600