Projé Inc · 18 hours ago
HealthRules Payer Sr. Project Manager- Health Insurance
United States
Full-time
Remote
Senior Level
$135K/yr - $165K/yr
5+ years expProjé Inc. is a woman-owned consulting firm providing advisory consulting services in the health care industry. They are seeking a Sr. Project Manager to lead the implementation of HealthRules Payer systems, ensuring successful project execution and stakeholder engagement across various functional areas within a health insurance organization.
Professional Services
Responsibilities
Uses program and project management experience, training, and skills to run successful projects within a Health Insurance Organization, specifically a HealthRules Payer claims system Implementation/Migration
Proven Expertise in HealthRules Payer and the functional areas within a health insurance organization, including enrollment, billing, claims, finance, provider, benefits, and medical management (GuidingCare)
Engages with multiple stakeholders at all levels of the organization, including executives, directors, managers, and individual contributors
Ensures that the business teams integrate their designs so that functional areas do not make design decisions in a silo and that any crossfunctional impacts are coordinated
Coordinates the global design with the vendor to ensure that business needs are viewed in whole rather than at a functional level only
Coordinates crossfunctional UAT and E2E testing needs and ensures that the endtoend business processes are tested appropriately
Provides configuration expertise for HealthRules Payer, and onthejob guidance and training for other project staff
Responsible for managing configuration alignment across areas to support a complete and cohesive solution
Ensures that configuration methodology is followed and documentation is maintained
Leads configuration change control processes
Provides strategic advice to the Program Delivery Team
Owns and manages the program Functional teams
Ensures that overall business needs are addressed as related to the scope
Ensures deliverables are on track and escalates any projectrelated issues
With Domain Functional Leads, ensures that issues and risks are managed and mitigated
Alerts Program Delivery Team of significant potential program risks and makes recommendations concerning risk mitigation, scope change, and other key issues
Participates in the Change Control process within the Functional Domain
Responsible for functional requirement traceability between requirements gathered, design documents, workflows, and the configuration workbook
Develops and manages a project schedule throughout the project life cycle, from initiation through postimplementation
Applies formal Change Management processes when substantive modifications affecting the project scope, timeline, or resources/budget are suggested or necessary
Ensures the project team provides highquality and costeffective analytical support services
Facilitates and/or leads process improvement discussions and ensures that current state, desired state, and gaps are welldocumented for the development of recommendations
Facilitates issue resolution through analysis and collaboration; develops and presents recommendations to leadership and negotiates to reach a resolution
Support postimplementation stabilization and project closure activities
Qualification
Required
Must have hands-on experience in the HealthRules Payer claims system and understand the configuration of that system
Prior experience with a HealthRules Payer and GuidingCare Implementation or conversion required
Proven success in multiple project implementations within a health insurance company in claims, billing, provider, enrollment, benefits, and medical management (GuidingCare), etc
Ability to manage functional leads and functional domain areas in a large enterprise project
Demonstrated strong expertise in HealthRules Payer configuration, while providing hands-on guidance and training to project team members
Able to understand and impartially consider project needs among diverse colleagues in various departments of the same organization
Ability to produce accurate and precise work, detect and resolve discrepancies all while meeting deadlines
History of exemplary relationship management and effective communication with project sponsor, leaders, and team members from across the healthcare organization
Proficiency with MS Office Suite (Outlook, Word, Excel, PowerPoint), MS Project, and Visio required
Bachelor's degree in healthcare administration or related field. Four (4) years of experience managing projects within a health care organization may be considered in lieu of a bachelor's degree
Hands-on experience with HealthRules Payer across key functional areas, including enrollment, claims, billing, finance, provider management, medical management, and benefits
At least five (5) years of experience working within a medical health care (insurance) organization
Three (3) years of experience managing one or more phases of a small to medium-sized project involving a minimum of five (5) cross-functional team members in a matrixed health care organization or closely related industry
Preferred
Proficiency with SharePoint, Access, and SQL preferred
Familiarity with various project methodologies (Waterfall, Agile, SaFe, Hybrid)
PMP, PgMP, Scrum Master, Six Sigma Belt certification preferred
Benefits
Competitive pay and bonuses
Excellent benefits (medical, dental, vision)
401K with percentage company match
Paid holidays and vacation days
Flexible schedule
Company
Projé Inc
Projé, Inc.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase