Position Purpose: Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities. Plan, organize, monitor, oversee and lead multiple, concurrent resultant projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives.
Education/Experience: Bachelor s degree in Business Administration, Healthcare Administration, related field, or equivalent experience. Master s degree preferred. 5+ years project implementation, product or program management experience. Managed care or prescription benefit management experience preferred.
Responsibilities:
" Identify opportunities to increase efficiency, improve service levels and to ensure regulatory compliance through enhanced operations
" Develop strategies to realize improvement opportunities, and ensure organizational prioritization and resource alignment
" Manage multiple projects through full project life cycle process including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure
" Utilize corporate and industry standard project management tools and techniques to effectively manage projects
" Maintain detailed project documentation as needed including action items, issues lists and risk mitigation plans
" Provide leadership and effectively communicate project status to all stakeholders, including executive summaries and presentations
" Negotiate with project stakeholders to identify and secure resources, resolve issues, and mitigate risks
" Lead cross-functional meetings with various functional areas to meet overall stakeholder expectations and company s objectives
" Provide functional and technical knowledge regarding overall program requirements and operations
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
============
| Story Behind the Need |
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
| - The Purpose of this team is to help keep compliance oversight/monitoring as well as corrective action improvement projects on track in order to help our members achieve outcomes and ensure we are always audit ready.
- Currently, 1 person is driving this work and assistance is needed to keep the projects on track
- Key projects are listed below. Our team has a culture of transparency, cross departmental collaboration and continuous learning. We work hard at being supportive of each other and following the core values of Centene.
- Currently, I only have the 2 PM positions open.
|
| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| Project Manager 1: Audit, Compliance & Regulatory Readiness
Regulatory Audits & Mock Audits- Develop and maintain annual audit readiness workplans.
- Coordinate CMS, NCQA, state, internal audit, and mock audit activities.
- Manage audit calendars, milestones, and deliverables.
- Ensure required universes, questionnaires, case files, and evidence are collected and validated.
- Maintain audit tracker and issue log.
- Facilitate audit preparation meetings and practice sessions.
Audit Logistics- Coordinate room procurement and audit command center setup.
- Arrange audiovisual equipment, conference lines, virtual meeting capabilities, and technology testing.
- Coordinate meals and catering.
- Manage attendee lists, schedules, and audit-day support.
- Maintain audit document repositories and evidence inventories.
Case Review Preparation- Coordinate case selection and readiness reviews.
- Establish presentation schedules.
- Manage speaker, presenter, and researcher assignments.
- Track deficiencies identified during pre-audit reviews.
- Validate documentation completeness prior to presentation.
Internal Audit Remediation- Maintain remediation action plan tracker.
- Monitor corrective action progress.
- Coordinate root cause analysis activities.
- Escalate overdue remediation items.
- Prepare executive remediation status reports.
- Validate closure evidence prior to compliance sign-off.
Compliance Governance- Track compliance issues and associated corrective actions.
- Coordinate regulatory requirement implementation.
- Monitor policy and process updates resulting from regulatory changes.
- Maintain compliance committee reporting packages.
- Support annual compliance program activities and readiness reviews.
Project Manager 2: Operations, Vendors, Reporting & Implementation
Reporting Governance- Inventory and maintain all operational reports and dashboards.
- Coordinate report testing and validation efforts.
- Manage report enhancement requests.
- Monitor report accuracy and data quality issues.
- Coordinate user acceptance testing (UAT).
- Maintain report requirement documentation and change logs.
Contract & New Requirement Management- Review new state and federal regulatory requirements.
- Coordinate implementation of contractual requirements.
- Track requirement ownership and completion status.
- Facilitate gap assessments.
- Manage requirement traceability matrices.
- Ensure cross-functional stakeholder accountability
Annual Enrollment Readiness- Coordinate Annual Enrollment Period (AEP) and Open Enrollment operational changes.
- Track readiness milestones.
- Coordinate workflow updates tied to enrollment changes.
- Validate training and communication deployment.
- Monitor implementation risks and dependencies.
Vendor Oversight- Coordinate vendor governance meetings.
- Maintain vendor issue and risk logs.
- Track SLA performance and operational metrics.
- Monitor delegated and contracted entity commitments.
- Support vendor corrective action plans.
- Coordinate contract amendment implementation.
Training Oversight- Maintain annual training inventory and schedule.
- Track training completion requirements.
- Coordinate new training development requests.
- Monitor regulatory and MOC training requirements.
- Ensure training evidence is maintained for audits.
- Coordinate retraining and remediation activities.
Job Aid Governance- Manage job aid inventory.
- Coordinate updates resulting from workflow, policy, or audit findings.
- Ensure version control.
- Track business owner approvals.
- Maintain publication schedules.
- Monitor implementation and staff adoption.
Shared Responsibilities
Both PMs should jointly:- Maintain RAID logs (Risks, Assumptions, Issues, Dependencies).
- Facilitate weekly leadership status meetings.
- Produce executive status reports.
- Manage cross-functional stakeholder communications.
- Coordinate resource planning.
- Track key performance indicators.
- Support strategic initiatives and governance activities
|
| Candidate Requirements |
| Education/Certification | Required: Bachelor s Degree required | Preferred: PMP strongly preferred |
| Licensure | Required: N/A | Preferred: |
Years of experience required: 5+ years of project management
Disqualifiers:
Additional qualities to look for: Healthcare and regulatory/compliance experience |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Build and manage project plans coordinating cross-functional teams |
| 2 | Develop and track timelines and milestones for risks, issues, dependencies and decisions |
| 3 | Manage status reporting and drive projects to completion |
| Candidate Review & Selection |
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
| Projected Manager Candidate Review Date: | 1-2 days post shortlisting |
Type of Interviews:
| Teams |
| Required Testing or Assessment (by Vendor): | Typing test, basic computers skills test, etc. |