Job Description:

We are seeking an experienced Project Manager with strong healthcare domain expertise, specifically in Medicare Advantage, DSNP, Medicaid, or Exchange programs. This role will focus on managing and delivering medium to high complexity projects involving Pharmacy Benefits, provider networks, claims, and state readiness initiatives. The ideal candidate should have a proven track record in project leadership, stakeholder engagement, and health plan operations.

Key Responsibilities:

• Manage end-to-end healthcare projects across Medicare/Medicaid/Exchange programs.

• Lead planning, execution, and delivery of pharmacy and medical benefit projects.

• Collaborate with Pharmacy Benefit Managers (PBMs) and set up pharmacy call centers.

• Coordinate development of member and provider materials, ensuring compliance.

• Track and manage RAID logs (Risks, Assumptions, Issues, Dependencies).

• Create and maintain project charters, work breakdown structures, and schedules.

• Work with SIT and E2E UAT teams on test planning and support (optional but preferred).

• Facilitate state readiness reviews and prepare project documentation for audits.

• Ensure effective change control, scope management, and timely escalation.

• Maintain communication with business, IT, and executive stakeholders.

• Drive cross-functional communication, milestone delivery, and process improvements.

Professional Skills:

• Strong knowledge of Medicare Advantage / DSNP / Medicaid / Exchange program operations.

• Experience in pharmacy benefits, plan design, and PBM coordination.

• Familiarity with eligibility, enrollment, claims, encounters, and provider data.

• Hands-on experience with project budgeting and status reporting tools.

• Knowledge of state healthcare regulations and compliance readiness.

• Strong communication, presentation, and documentation skills.

• Ability to lead cross-functional teams in a hybrid or matrixed environment.

• PMP or Agile certification is a plus.