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Partnership HealthPlan of California · 4 hours ago

Sr. Medicare Project Manager

US-CA-Fairfield

Full-time

Onsite

Mid, Senior Level

$119K/yr - $154K/yr

5+ years exp

Partnership HealthPlan of California is seeking a Senior Medicare Project Manager responsible for coordinating activities related to the Dual Eligible Special Needs Plan (DSNP) lifecycle. This role involves ensuring compliance with CMS requirements and managing all aspects of AEP operational readiness while collaborating with various internal and external teams.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

In collaboration with RAC, manages the CMS application process in alignment with CMS timelines

Works with Finance to coordinate bid preparation, ensuring accuracy and compliance with program requirements

Collaborates with RAC in the application submission and maintain documentation for audit readiness

Supports DSNP development, planning, product implementation, and monitors operational performance

Collaborates with cross-functional teams (Compliance, Provider Engagement, Enrollment, Claims, Customer Service, UM/CM, Sales, Marketing, Quality, Finance) to ensure readiness and adherence to CMS standards

Partners with the Marketing team to execute DSNP marketing strategies and ensures compliance with CMS marketing guidelines

Oversees production and distribution of ID cards, member letters, and other required communications

Develops and manages the DSNP AEP readiness plan, including timelines, deliverables, and risk mitigation strategies

Monitors CMS guidance and state regulations to maintain adherence throughout AEP activities

Tracks and reports readiness metrics to leadership, identifying gaps and implementing corrective actions

Facilitates training and readiness sessions for internal stakeholders

Serves as the primary point of contact for DSNP AEP readiness inquiries and escalations

Identifies process improvement opportunities and implements best practices

Manages projects with low to high complexity and greater ambiguity, involving both interdepartmental and external stakeholders

Identifies and manages project deliverables, risks, dependencies, communication, and critical path for all assigned projects

Develops and maintains project plans, project charters, and budget summaries

Works with subject matter experts and department representatives to develop, streamline, and implement newly established processes

Responsible for successful hand-off of established processes and project deliverables to appropriate business owner(s)

Ensures projects stay on track by effectively following-up with project stakeholders and subject matter experts on outstanding project deliverables

Works autonomously in managing day-to-day project execution

Uses independent judgement to estimate project resource needs, identify time and resource constraints, and develops/adjusts project plans accordingly

May supervise and provide guidance to staff as assigned

Develops business cases, project charters and other project documentation, and presents to stakeholders as needed

Effectively utilizes project management software, tools, and resources needed for project planning and executions

Tracks, compiles, reviews, and analyzes project data and results

Oversees the tracking of tasks, timelines and resources necessary to meet project objectives while keeping within cost, scope, schedule and resource requirements

Maintains project documentation per department specifications

Communicates with project team, stakeholders and leaders on status, potential risks, issues, or dependencies associated with projects in a timely manner

Develops and distributes communications to project stakeholders

Effectively utilizes online collaboration applications

Coordinates and facilitates both internal and external meetings

Develops and publishes agendas, meeting minutes, and necessary documentation

Plans and coordinates events, conferences, and webinars, as needed

Other duties as assigned

Qualification

Medicare Advantage experienceDSNP program managementCMS regulations knowledgeProject Management Professional (PMP)Lean Six Sigma GreenbeltData analytics toolsProject management methodologiesCommunication skillsInterpersonal skillsProblem solving skillsOrganizational skillsAdaptability

Required

Bachelor's degree and at least five (5) years of relevant project management experience required

In lieu of a degree, a minimum of eight (8) years of relevant experience to include a minimum of five (5) years project management experience will be considered

Five (5) or more years of experience in Medicare Advantage or DSNP program management required

Strong knowledge of CMS regulations and AEP processes

Experience with health plan operations, Medi-Cal and member engagement strategies

Familiarity with data analytics and reporting tools

Experience managing multiple complex projects with teams of 10 or more

Strong communication skills, both verbal and written, to interpret and articulate project requirements to involved stakeholders

Exceptional interpersonal and customer service skills

Strong networking/relationship building skills, able to positively influence and create buy-in across groups, and maintains effective working relationships across all levels within the organization

Detail-oriented

Strong organization skills with ability to work on multiple projects at one time and efficiently complete assigned projects within established timeframes and quality standards

Solid decision-making, problem solving, critical thinking skills

Able to work under pressure and meet critical deadlines in a fast-moving environment

Adaptable to a continuous changing environment

Strong project management/operational background

Understands and utilizes project management methodologies and tools

Proficient experience in use of various computer system software including Windows, Microsoft Word, Excel, Outlook, Visio, and PowerPoint

Preferred

Experience in health plan environment preferred

Project Management Professional (PMP) or Lean Six Sigma (LSS) Greenbelt certification preferred but not required

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees