Project Manager – Health Plan Operations (Remote, PST Hours)
Pay Rate: $62.34/hour
Schedule: Monday – Friday, 8:00 AM – 5:00 PM PST
Location: Remote (Must reside in AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY [outside greater-NYC], OH, TX, UT, WA [outside greater-Seattle], or WI)
This is a 9-month contract with a possible extension or direct hire.
About the Role:
Our Client is seeking a detail-oriented Project Manager with a background in managed care, utilization management, or claims to support cross-functional healthcare initiatives. In this role, you will oversee intermediate to large-scale projects, including system implementations, internal process improvements, new health plan launches, and product line rollouts. You’ll collaborate closely with internal teams, external corporate departments, and delegated provider groups to ensure timely and accurate execution.
Key Responsibilities:
Project Leadership: Manage all aspects of assigned projects including scope, timeline, resources, costs, risks, and change management.
Project Planning & Reporting: Create and maintain detailed project plans, schedules, and status reports.
Cross-Functional Coordination: Act as a liaison with internal SMEs, external departments, and health plan partners.
Process Improvement: Develop workflows and process solutions to enhance operational efficiency.
Communication: Lead regular project meetings, document outcomes, and ensure stakeholder alignment.
Claims & Report Management: Track IPA report submissions and claims; troubleshoot reporting issues with delegated entities.
Education & Support: Provide guidance and training to external partners to ensure report accuracy and timely data entry.
Must-Have Requirements:
Knowledge of Managed Care, especially Utilization Management or Claims
Proficiency in Microsoft Excel and related applications (Word, PowerPoint, Visio, Project)
Strong communication, problem-solving, and analytical skills
Ability to work independently and meet deadlines while supporting team efforts
Preferred Skills & Abilities:
Familiarity with health plan operations, sub-processes, and key metrics
Understanding of the differences between various health plan product lines
Proven ability to manage multiple priorities and large-scale projects
Comfort with HIPAA compliance and maintaining confidentiality
Excellent organizational skills and attention to detail
Education & Experience:
Bachelor’s degree required
2–4 years of formal project management experience
2–4 years of experience with systems implementations in healthcare or similar environments