Manager, Project Management jobs at Highmark

HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. Responsible for definition, planning and delivery of complex programs that require cross-functional collaboration and management of interdependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget. Includes the management of a group of internal exempt and/or matrixed employees and contractors that serve on the program(s) to deliver solutions for the business. **ESSENTIAL RESPONSIBILITIES:** + Works with business and technical organizations to drive out program strategy and approach. Organizes, plans, and maintains Program roadmap consisting of cross-functional activities/projects. + Work with business and technical organizations to assemble project teams. Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program. + Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives. Acquire understanding of the business objectives for an assigned area." + Monitor, evaluate and report on Program status inclusive of scope, schedule, budget and alignment to Program and strategic goals. Direct corrective action as needed to maintain the viability of the Program. + Develop and maintain positive customer relationships. Deliver presentations of project status to effectively communicate throughout the project lifecycle. + Adhere to Highmark project management methods, project lifecycle methodologies, and audit requirements. Support and contribute to the improvement of project management methods and practices. + Other duties as assigned or requested. **QUALIFICATIONS:** Minimum + High School Diploma or equivalent + One (1) to three (3) years experience performing project coordination activities such as analysis, information gathering, documentation preparation, project schedule maintenance, status report preparation, budget tracking, etc. Preferred + Bachelor's degree + PMP certification or equivalent training + Health Care Insurance industry business and operational knowledge + Leadership skills + Solid organizational and planning skills + Exposure to an industry standard software development lifecycle + Good verbal and written communication skills + Good interpersonal skills **Knowledge, Skills and Abilities** + Experience with customer relationship management + Presentation skills + Negotiation skills + Experience with conflict resolution + Experience with Risk Mitigation Planning **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $50,200.00 **Pay Range Maximum:** $91,200.00 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J271523

**Become a part of our caring community and help us put health first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and providers, with full accountability from strategy to execution. The Lead Product & Strategy Manager - Provider Practice Management role is a critical member of the multidisciplinary clinical initiatives team within Clinical Strategy and Analytics. This role is not a traditional software product manager role. Instead, it requires demonstrated expertise in healthcare delivery, provider performance improvement, operational redesign, and translating insights into actionable workflows for clinical practices. The Lead Product & Strategy Manager will work across clinical initiatives focused on reducing 30-day Plan All-Cause Readmissions (PCR). They will partner closely with high-performing and low-performing provider groups to identify clinical best practices, understand operational gaps, and design and operationalize provider-facing improvements that lead to measurable performance lift. They must be highly collaborative, able to work cross-functionally across Humana and external provider partners, and able to drive execution (not just strategy) in a fast-moving environment. **Key responsibilities of the position are as follows:** Best Practice Identification + Engage with high-performing provider groups to understand clinical workflows, transitional care processes, and operational drivers that contribute to lower readmission rates. + Conduct targeted discovery with low-performing providers to identify barriers, workflow breakdowns, staffing constraints, or data usability issues that inhibit execution of best practices. + Translate field insights into a clear set of best practices and operational playbooks that provider organizations can adopt to meaningfully reduce readmissions. Product & Insight Development + Partner with Clinical Analytics to understand key data patterns and root causes of readmissions and convert these signals into provider-friendly insights. + Lead the design and refinement of provider-facing data views (dashboards, insights, performance summaries) to ensure they are actionable, timely, and aligned to provider workflows. + Work with product leads and data teams to prioritize enhancements that make insights easier for providers to use - e.g., surfacing patients most likely to readmit, highlighting missed touchpoints, or flagging operational risk. Execution With Providers & Internal Stakeholders + Serve as the primary operational liaison with targeted provider groups, ensuring best practices are activated and sustained. + Co-develop and support rollout of interventions such as transitional care workflows, follow-up protocols, huddle tools, or care-team guidance that directly reduce readmission risk. + Work with enterprise partners (e.g., care management, clinical programs, analytics, population health) to ensure alignment and remove operational barriers to provider adoption. Strategy & Impact Measurement + Define the strategic roadmap for provider practice improvements related to PCR. + Set measurable targets, track provider engagement, and monitor performance lift over time. + Synthesize complex clinical, operational, and analytic information into clear recommendations for executive leadership. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + 7 or more years of experience in population health strategy, health outcomes strategies and/or provider practice management OR 3 years of management consulting with additional 2-3 years of professional work experience + Strong understanding of transitional care management + Experience working directly with provider groups, clinical leaders, or care teams + Experience in advanced primary care or high-performance provider model organizations (e.g., ChenMed, Oak Street, Cityblock, Iora, CareMore) + Strong data literacy with demonstrated experience using analytics to drive operational insights + Excellent communication, relationship-building, and cross-functional collaboration skills + Ability to independently manage complex initiatives, work across departments, and drive execution without day-to-day oversight **Preferred Qualifications** + Background as a clinician (RN, NP, PA, MD, PharmD, or similar) + Experience with population health workflows and drivers of 30-day readmissions + Experience in management consulting and clinical practice (ideal but not required) + Expertise in provider workflow optimization, care transitions, or readmission reduction programs + Familiarity with EHR workflows and system integrations + Demonstrated ability to translate analytics into operationally executable solutions **Additional Information** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $126,300 - $173,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-02-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Become a part of our caring community and help us put health first The Encounter Data Management Lead supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement (HQRI) organization. This position is responsible for ensuring the accurate and timely submission of encounter data to Medicaid, Medicare, and DSNP states, while maintaining adherence to all regulatory requirements. The Lead utilizes strong analytical skills and attention to detail and collaborates effectively with cross-functional teams to drive process improvements and enhance communication and collaboration across the organization. The Encounter Data Management Lead is responsible for ensuring the integrity and accuracy of Medicaid and Medicare encounter data across multiple trading partners. This role collaborates with Product Owners and business contract owners to facilitate accurate and compliant encounter data submissions. The Lead manages the resolution of complex data issues while supporting business contract teams across multiple trading partners. Use your skills to make an impact Required Qualifications Minimum of 2 years' professional experience in Medicaid data management, healthcare operations Ability to monitor product performance, resolve production environment issues, and communicate timely updates to business stakeholders. Strong ability to facilitate effective meetings, lead collaborative discussions, and clearly communicate project status, issues, and solutions to business stakeholders. Knowledge in Agile ceremonies, including backlog refinement, sprint planning, and Program Increment (PI) planning. Proficiency in Azure DevOps, including experience reviewing high level testing activities. Demonstrated ability to lead cross-functional collaboration and foster effective team engagement. Exceptional interpersonal and relationship-building skills, with the ability to engage and influence diverse stakeholders, including technical teams and business partners. Ability to translate complex data findings into clear, actionable business recommendations for non-technical audiences. Experience delivering professional presentations, reports, and documentation to support cross-functional initiatives and decision-making. Experience using SQL and data analytics tools to track, trend, and resolve data issues. Demonstrated authority to define product direction, with a consistent focus on advancing key business objectives. Preferred Qualifications Lean or Six Sigma certification. Hands-on experience in encounter data submissions Background in Medicare and/or Medicaid product management or support. Familiarity with Claims Adjudication Systems (CAS). Knowledge of X12 transaction sets and standards. Proficiency in SQL for data analysis and management. Work-At-Home Requirements WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 12-15-2025 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

**Become a part of our caring community and help us put health first** Join Humana's In Home Well-being Assessment (IHWA) team team and lead the management of key vendor relationships that drive in-home health and well-being assessments for Medicare members. As a Program Delivery Lead, you'll own vendor partnerships, monitor contractual obligations, and ensure compliance with CMS guidelines-all while supporting Humana's Retail bid goals and Medicare Risk Adjustment requirements. This role requires strong task management, project management, independent decision-making, and the ability to operate in times of ambiguity. **Key Responsibilities** + Serve as the primary point of contact for one or more IHWA vendors, building strong, productive partnerships. + Manage and monitor vendor deliverables, contractual obligations, and service-level agreements. + Track, prioritize, and oversee a high volume of vendor activities while supporting internal Humana partners. + Ensure compliance with CMS guidelines and Medicare Risk Adjustment standards. + Collaborate with Stars program teams to manage vendor activities tied to quality and risk adjustment goals. + Operate independently, make decisions in ambiguous situations, and manage multiple projects simultaneously. + Proactively identify issues, communicate findings, and influence process improvements. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree or equivalent experience + 6 or more years of large project implementation or vendor management + 2 or more years of project leadership experience + Strong knowledge of Microsoft Office XP products (Word, Excel, Access) + Excellent communication skills, both oral and written + Strong relationship building skills + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Required Travel:** Quarterly vendor meetings required, plus occasional ad hoc travel. Estimated total travel: **6-7 trips per year** . **Preferred Qualifications** + Master's Degree in Business Administration or a related field + PMP certification a plus + Six Sigma Certification also a plus + Knowledge and experience in health care environment/managed care + Strong analytical skills **Additional Information** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-11-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Location: Must live in Oklahoma. Schedule: M-F, 8-5 CST; occasional after-hours based on plan needs. Managed care + clinical experience in L&D, OB, or NICU. Strong maternal-child clinical knowledge to support compliance and care quality. Experience guiding teams. Able to adjust quickly to changing priorities. Position Purpose: Manages the care management team and the care coordination of behavioral health members to develop and assess high quality, cost-effective healthcare outcomes related to mental and behavioral health needs. Manages escalations and care management issues related to members or providers. Oversees and reviews care management required documentation to maintain compliance with federal and state regulations and contractual agreements Develops, implements, and oversees care management policies and procedures within the care management team based on regulatory requirements and industry standards Directs the daily activities of care management staff including reviewing and approving the caseloads of care management staff based on state requirements, care management staff experience, and member needs Manages escalated and complex care cases, and provides guidance to team members to address member concerns related to mental and behavioral health members Manages resolutions of complaints and assists in audits and evaluations related to care programs Develops, implements, and oversees care management programs to facilitate the use of appropriate services and resources Sets goals and objectives for care management team to achieve cost-effective healthcare results Works with care management senior management to provide updates and insights on care management team goals Provides feedback to care management team to improve member and provider experience and high-quality care Educates and provides resources for care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers Assists care management senior leadership with onboarding, hiring, and training new care management employees, recent promotes, and transfers within the department Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires a Master's degree or Graduate from an Accredited School of Nursing and 5+ years of related experience. License/Certification: Licensed Clinical Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, and RN with BH experience required Pay Range: $100,900.00 - $186,800.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Project Manager supports the CMO of the Buckeye Community Health Plan and clinical leadership teams by coordinating, organizing, and driving cross-functional initiatives that enhance clinical operations and improve outcomes. This role ensures efficient project execution across multiple departments by facilitating communication, aligning stakeholders, and guiding projects from ideation through completion within a dynamic, matrixed environment. The Project Manager is expected to understand the clinical context of the work, strengthen communication across teams, maintain momentum on all assigned initiatives, and properly document and archive project activities and outcomes. Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure Facilitate communication across VP, Director, Manager, and Strategist-level stakeholders Ensure alignment between clinical priorities and project workflows Utilize corporate and industry standard project management tools and techniques to effectively manage projects. Assist with establishment and maintenance of corporate project management methodology and other department procedures Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans Provide leadership and effectively communicate project status to all stakeholders, may include written executive summaries Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives Promote collaboration across a dynamic, matrixed environment Provide functional and technical knowledge across multiple business and technical areas Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation Key Teams Supported You will collaborate with a broad range of cross-functional clinical and operational groups, including but not limited to: Care Coordination Utilization Management Population Health Quality Medical Affairs Health Equity Pharmacy Other provider- and member-facing teams You will also partner closely with our in-market Data Analytics team. Education/Experience: Bachelor's degree in Business Administration, Healthcare Administration, related field, or equivalent experience. Master's degree preferred. 4+ years of project management and implementation or program management experience. Proficient with MS Office applications and project management tools. Experience working with and leading diverse groups and matrix managed environments. License/Certification: PMP, PgMP, or CAPM preferred. This position is hybrid/remote with strong preference to candidates within the state of Ohio. In office expectation for local candidates monthly or as needed. Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

The Program Manager will actively maintain the product and program pipeline for enhancements, possess in-depth knowledge of program membership and enrollment changes, and guide continuous improvement efforts by managing feedback loops. This position requires significant cross-functional collaboration and managing interdependencies within a group of projects and related activities, all within defined scope, quality, time, and budget constraints, and under circumstances involving multiple moderate-probability, moderate-impact risk factors. **ESSENTIAL RESPONSIBILITIES** + Develop program goals, objectives, and roadmaps that align with the company's overall strategy. + End-to-end ownership, definition, implementation, and continuous evolution of complex Specialty Pharmacy programs that include comprehensive program management, product management, and program effectiveness responsibilities. + Serve as the main point of contact for stakeholders, providing regular updates on progress, goals, and challenges. + Designing program dashboards, actively monitoring program health, and collaborating with Pharmacy Analysts/Consultants for variance investigations, inquiries, and audits. + Manage a matrix group of employees and contractors on project teams or within departmental work groups to achieve coordinated program benefits. + Guide the stakeholders through the process by evaluating risks and providing a communication plan. FTE would provide support during and after the implementation. + Identify potential risks, develop mitigation plans, and resolve issues that arise during the program lifecycle. + Track progress, monitor key performance indicators, and make adjustments as needed to ensure project and program goals are met. **RESPONSIBILITIES** **EDUCATION** **Minimum** + High School Diploma / GED **Substitutions** + None **Preferred** + Bachelor's degree in Business Administration or Technology Management-related area of study + MBA or Master's Degree in Technology Management-related area of study **EXPERIENCE** **Minimum** + 7 -10 years of work experience in project management or + 7-10 years of work experience delivering business solutions using information technology **Preferred** + Managing large-scale, cross-functional projects and complex initiatives. + Experience with risk management, change management, and process improvement **LICENSES/CERTIFICATIONS** **Required** + None **Preferred** + PMP or Certification in Project Management **SCOPE OF RESPONSIBILITY** Does this role supervise/manage other employees? No **WORK ENVIRONMENT** Is Travel Required? Yes **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement:_** _This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies_ **Note: Job duties and responsibilities support separation of duties across multiple users** As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. **Pay Range Minimum:** $78,900.00 **Pay Range Maximum:** $147,500.00 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J271347

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Develop, implement and manage strategic fraud, waste and abuse (FWA) activities by maintaining state and federal requirements and monitoring trends/schemes in Ohio and Oklahoma markets. Develop internal processes for enhanced FWA detection and investigation completion. Evaluate the department policies and procedures to ensure employee compliance and enhance daily processes Prepare the annual audits complying with federal program regulations and participate in CMS audits and new business implementations Monitor business processes and systems to assure integrity and compliance in billing and claims payment Serve as a lead and investigate all possible fraud, waste and abuse referrals Develop customized fraud plans to meet contract and federal requirements Review educational materials to identify waste activities as requested by the health plan and on an ad-hoc basis Respond to RFP request and implement new policies per contractual obligation Attend state and federal meetings as required Prepare and distribute monthly and quarterly saving reports Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience. 6+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance or fraud and abuse experience. Thorough knowledge of medical terminology required. Experience in managed care environment and as supervisor of staff, including hiring, training, assigning work and managing performance. Knowledge of medical coding, claims processing, and data mining. License/Certificates: Medical records, fraud investigation or coding license preferred.Pay Range: $105,600.00 - $195,400.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Project Manager supports the CMO of the Buckeye Community Health Plan and clinical leadership teams by coordinating, organizing, and driving cross-functional initiatives that enhance clinical operations and improve outcomes. This role ensures efficient project execution across multiple departments by facilitating communication, aligning stakeholders, and guiding projects from ideation through completion within a dynamic, matrixed environment. The Project Manager is expected to understand the clinical context of the work, strengthen communication across teams, maintain momentum on all assigned initiatives, and properly document and archive project activities and outcomes. + Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure + Facilitate communication across VP, Director, Manager, and Strategist-level stakeholders + Ensure alignment between clinical priorities and project workflows + Utilize corporate and industry standard project management tools and techniques to effectively manage projects. + Assist with establishment and maintenance of corporate project management methodology and other department procedures + Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans + Provide leadership and effectively communicate project status to all stakeholders, may include written executive summaries + Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks + Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives + Promote collaboration across a dynamic, matrixed environment + Provide functional and technical knowledge across multiple business and technical areas + Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation **Key Teams Supported** You will collaborate with a broad range of cross-functional clinical and operational groups, including but not limited to: + Care Coordination + Utilization Management + Population Health + Quality + Medical Affairs + Health Equity + Pharmacy + Other provider- and member-facing teams You will also partner closely with our in-market Data Analytics team. **Education/Experience:** Bachelor's degree in Business Administration, Healthcare Administration, related field, or equivalent experience. Master's degree preferred. 4+ years of project management and implementation or program management experience. Proficient with MS Office applications and project management tools. Experience working with and leading diverse groups and matrix managed environments. **License/Certification:** PMP, PgMP, or CAPM preferred. This position is hybrid/remote with strong preference to candidates within the state of Ohio. In office expectation for local candidates monthly or as needed. Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. 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. Responsible for managing a portfolio of cross functional healthcare transformation initiatives that align with company goals and drive results. Lead the ideation and identification of initiatives to increase efficiency, improve service levels, and innovate. Identify impacts, risks and interdependencies and support development and make recommendations to senior leadership based on findings. Develop strategies to realize improvement opportunities, and ensure organizational prioritization and resource alignment Monitor initiatives to drive performance and analyze data to determine trends and opportunities Ideate and identify initiatives for the portfolio 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 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.Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Program Manager III, Skills Strategy & Enablement plays a key role in advancing Centene's workforce performance and skills transformation strategy. This role bridges data, design, and delivery to translate workforce insights into actionable programs and tools that drive internal mobility, close skills gaps, and align workforce capabilities with strategic business objectives. ***The Program Manager III, Skills Strategy & Enablement is primarily remote. Candidates will be considered nationally. *** Responsibilities: Support skills taxonomy implementation and governance processes across the enterprise Facilitate integration efforts between skills platforms and existing HRIS and People Systems Partner with HR Analytics and internal teams to review, and validate skills data used for reporting Build or maintain basic dashboards or visual views in Power BI, Tableau, or similar tools to support program insights. Help translate workforce insights into clear, simple summaries for non-technical audiences Facilitate cross-functional workshops for framework validation Contribute to the creation and refinement of capability frameworks, skills libraries, and learning pathways that enable growth at scale Design and maintain knowledge architecture that connects skills, roles, and career progression across business units Implement career development, career pathing, and internal mobility program components as skills journey is advanced 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 Smartsheet 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 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 Highly Preferred Skills: HR Project and Program Management Workforce Data Analysis and Modeling Governance and Standards Change Management Facilitation HR analytics & data analysis Beginner to intermediate skill level in Power BI, Tableau, or similar Data Visualization tools Stakeholder Collaboration and Influence Communication and Storytelling Agility and Adaptability 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. Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: With the Corporate Medical Affairs Operations team, you will support our Regional Medical Affairs Teams primarily overseeing Medical Affairs operations for Medicaid and Ambetter products. This position will be a primary resource for our regional leaders to align with leaders on strategic goals, and provide business insights through data to influence performance trends to meet targets. Strategic initiatives that come up for the regions will also be managed by this role for implementation. 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 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. Preferred Skills: Understand the end to end Utilization Management process with an emphasis on Medical Affair's role and upstream/downstream components. Translate strategic goals into measurable KPIs that reflect the true operations within the department and use those insights to communicate and influence our regional leaders. Key skills include: excelling in communication, moderate technical skills for data manipulation and presentation, tight organizational skills to maintain ongoing support for 4 regional units. Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Plan, organize, and oversee complex, cross-functional programs and projects that advance provider engagement, experience, and performance strategies. This role synthesizes multiple workstreams-including Engagement Operations, Data & Analytics, Digital Initiatives, Operational Strategy, and Experience Management-into a cohesive strategic roadmap. The Program Manager IV ensures alignment with organizational objectives, facilitates collaboration across shared services, and provides executive-level visibility through governance and reporting. Lead large scale, cross functional projects for implementation or process improvement including working with organizational leaders for restructuring and realignment of team members. Oversee all aspects of program planning, management, and execution (scope, schedule, and budget). Create comprehensive timelines and ensure the project team creates and maintains appropriate deliverables while following project management standards. Drive large scale projects by coordinating the work of one or more project managers/business analysts who are managing the individual workgroups (Operations, Finance, Benefit Operations, etc.) involved in the project. Create meaningful dashboards for executive level update and project status. Work with teams to create reports for ongoing analytics post project implementation. Create and deliver best practice and training information to indirect reports (when applicable), peers, and other employees. Work with the training team to create/review training materials. Prepare and deliver documents for Program Steering Committees to the Executive team. Work with functional business teams' leaders to assess program risks and issue escalate as needed to the leadership level. Proactively manage areas such as risk, budget/forecast, dependencies, etc. Prepare strategic analysis of potential business and/or operational opportunities as needed. Serve as the first escalation point for project issues and risks. Work directly with the project teams to resolve issues and create risk mitigation plans. Escalate well-formulated issues and risks to leadership. Effectively communicate business and technology issues and solutions. Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives, including synthesizing multiple provider strategy workstreams (Engagement Operations, Data & Analytics, Digital Initiatives, Operational Strategy, and Experience Management) into a cohesive executive-level strategic roadmap that translates initiatives into actionable priorities and enables day-to-day progress tracking and reporting. Develop and maintain governance frameworks to track progress, manage dependencies, and ensure accountability across initiatives. Partner with analytics teams to monitor provider performance metrics and deliver actionable insights to inform decision-making and continuous improvement. Education/Experience: Bachelor's degree in related field or equivalent experience required. Master's degree preferred. 8+ years of Program or Project Management experience required. Previous experience as a lead in a functional area, managing cross-functional teams on large scale projects or supervisory experience including hiring, training, assigning work, and managing the performance of staff required. Proficiency in MS Office applications and project management tools required. Healthcare experience and/or managed care experience preferred. License/Certification: Project Management Professional (PMP) or Program Management Professional (PgMP) preferred Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. THIS POSITION IS REMOTE, WILL WORK FROM ASSIGNED HOSPITALS: ST. LOUIS UNIVERSITY AND CARDINAL/GLENNON. APPLICANTS SHOULD RESIDE WITHIN A 20 MILE RADIUS OF THESE HOSPITALS. ROLE WILL SUPPORT THE HOSPITAL CARE MANAGER/CASE MANAGER TO SUPPORT OUR MEMBERS; WILL HANDLE DISCHARGE PLANNING BASED ON MEMBER ADMISSIONS. WORK SCHEDULE WILL BE MONDAY - FRIDAY 8AM - 5PM DURING THE TRAINING TIME FRAME. Position Purpose: Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care. Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs May identify problems/barriers for care management and appropriate care management interventions for escalated cases Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations Reviews referrals information and intake assessments to develop appropriate care plans/service plans May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness Other duties or responsibilities as assigned by people leader to meet business needs Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 - 6 years of related experience. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required. Pay Range: $73,800.00 - $132,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Advisory Manager (Strategy & Growth) Payer Consulting - Remote is the overall project lead across moderate-complexity engagement types and is responsible for determining overall approach and structure of analysis for engagement and key deliverables. The Manager (Strategy & Growth) Advisory Services will need substantial industry knowledge and will serve as the driving force behind team problem solving to help the clients identify strategic priorities, improve financial and market performance, rationalize services, and meet the many challenges that health care reform gives them. The Manager (Strategy & Growth) Advisory Services will assign workstreams to team members and self that reflect skills and development needs while meeting the needs and timelines of the client. This role will have a focus on project economics and will direct team to follow the practices needed to ensure both quality and profitability. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: * Overall project lead across moderate-complexity engagement types (or workstream lead for higher-complexity engagements) Ability to accurately diagnose the issues the client has identified (as well as underlying issues) and determine the appropriate strategic solutions * Build consensus among client stakeholders who play a critical role in the client's ability to successfully implement the identified solutions * Determining overall analytical approach and structure for engagement / workstream including key deliverables * Spend time coaching team members to develop approaches for their own sections when appropriate, reviewing and validating their work for accuracy and effectiveness * Principal point of day-to-day contact for client project lead * Establishes optimal communication cadence with client and demonstrates sufficient executive presence to lead onsite presentations * Assigns workstreams to team members and self that reflect skills and development needs while meeting needs and timelines of client * Focuses on project economics and directs team to follow practices needed to ensure both quality and profitability * Closely monitors actual vs. expected team utilization * Effectively and appropriately apply both deductive and inductive thinking * Provide subject matter expertise to other Optum Advisory Services business units as it relates to strategic planning * Provide support to other Optum Advisory Services business units when strategy expertise is required in dealing with client issues * Communicate effectively and accurately in writing and verbally to prospects, clients, and other staff * Demonstrate solid relationship management skills and ability to handle challenging interpersonal situations * Contribute to practice-level initiatives including business development and thought leadership beyond client project work You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 3+ years of healthcare, payer (primary) or life sciences experience * 3+ years of experience utilizing formal industry strategy frameworks * 3+ years working in payer strategy, provider network, NCQA/URAC accreditation, provider data management, or value-based care * Familiar with variety of strategy consulting frameworks and problem-solving approaches * Proficiency in MS Office Suite - Word, PowerPoint, Excel * Ability to travel domestically, up to 50% when required Preferred Qualifications: * 3+ years of experience in management consulting or payer strategy roles * Business development (client sales) experience * Experience mentoring junior level staff * Experience managing projects that achieved budget and timeline goals * Background in healthcare consulting * Proven analytical reasoning and solution-focus problem solving * Proven ability to lead and motivate cross-functional teams * Proven ability to work independently with minimal supervision * Proven ability to drill down to the root cause of issues and be creative in problem solving * Proven written and verbal communication skills in presenting to senior leadership and executives * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Advisory Manager (Strategy & Growth) Payer Consulting - Remote is the overall project lead across moderate-complexity engagement types and is responsible for determining overall approach and structure of analysis for engagement and key deliverables. The Manager (Strategy & Growth) Advisory Services will need substantial industry knowledge and will serve as the driving force behind team problem solving to help the clients identify strategic priorities, improve financial and market performance, rationalize services, and meet the many challenges that health care reform gives them. The Manager (Strategy & Growth) Advisory Services will assign workstreams to team members and self that reflect skills and development needs while meeting the needs and timelines of the client. This role will have a focus on project economics and will direct team to follow the practices needed to ensure both quality and profitability. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. **Primary Responsibilities:** + Overall project lead across moderate-complexity engagement types (or workstream lead for higher-complexity engagements) Ability to accurately diagnose the issues the client has identified (as well as underlying issues) and determine the appropriate strategic solutions + Build consensus among client stakeholders who play a critical role in the client's ability to successfully implement the identified solutions + Determining overall analytical approach and structure for engagement / workstream including key deliverables + Spend time coaching team members to develop approaches for their own sections when appropriate, reviewing and validating their work for accuracy and effectiveness + Principal point of day-to-day contact for client project lead + Establishes optimal communication cadence with client and demonstrates sufficient executive presence to lead onsite presentations + Assigns workstreams to team members and self that reflect skills and development needs while meeting needs and timelines of client + Focuses on project economics and directs team to follow practices needed to ensure both quality and profitability + Closely monitors actual vs. expected team utilization + Effectively and appropriately apply both deductive and inductive thinking + Provide subject matter expertise to other Optum Advisory Services business units as it relates to strategic planning + Provide support to other Optum Advisory Services business units when strategy expertise is required in dealing with client issues + Communicate effectively and accurately in writing and verbally to prospects, clients, and other staff + Demonstrate solid relationship management skills and ability to handle challenging interpersonal situations + Contribute to practice-level initiatives including business development and thought leadership beyond client project work You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + 3+ years of healthcare, payer (primary) or life sciences experience + 3+ years of experience utilizing formal industry strategy frameworks + 3+ years working in payer strategy, provider network, NCQA/URAC accreditation, provider data management, or value-based care + Familiar with variety of strategy consulting frameworks and problem-solving approaches + Proficiency in MS Office Suite - Word, PowerPoint, Excel + Ability to travel domestically, up to 50% when required **Preferred Qualifications:** + 3+ years of experience in management consulting or payer strategy roles + Business development (client sales) experience + Experience mentoring junior level staff + Experience managing projects that achieved budget and timeline goals + Background in healthcare consulting + Proven analytical reasoning and solution-focus problem solving + Proven ability to lead and motivate cross-functional teams + Proven ability to work independently with minimal supervision + Proven ability to drill down to the root cause of issues and be creative in problem solving + Proven written and verbal communication skills in presenting to senior leadership and executives *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As a Senior Financial Project Manager supporting the E&I accounting team, your primary duties will be a combination of Project management, systems, integration, and accounting/finance work. The successful candidate will need an understanding of the systems that support our financial reporting and an understanding of the data flows surrounding those systems. You'll need to partner/collaborate with our E&I accounting teams, as well as other functions within the organization to ensure successful project implementations, acquisition integrations and accurate documentation of financial processes, data flows and project decisions as they are impacted by various regulatory programs, new product launches or other changes in business. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Gain and maintain a working knowledge of the systems that support our accounting/finance functions * Document key processes and data flows * Develop, document, and implement project communication plans: Ensure clear and effective communication across all project stakeholders, drive decision making, risk mitigation, and concise project summaries with leadership * Work with Accounting/Finance teams impacted by new regulatory programs, products launches, system implementations and serve as a liaison between Finance and IT to develop requirements and to address implementation issues * Work with accounting teams from mergers, acquisitions and/or divestitures to integrate or segregate into UHC financial reporting systems and processes as needed * Develop and maintain relationships across business segments and departments * Develop approaches for continued improvement in efficiency and effectiveness * Serve as a Subject Matter Expert on various projects You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Bachelor's degree with concentration in Accounting or Finance * 5+ years of experience in Accounting/Financial Data Analysis/Accounting Systems * Solid understanding of financial accounting and GAAP * Project management experience with ability to manage end to end project execution from initiation to completion with strong current state/future state process mapping * Solid communication skills with the ability & confidence to drive discussions to conclusion/decisions on topics and the ability to summarize & document these decisions for leadership * Self-starter with excellent organizational skills and attention to detail * Experience with large volume data analysis * Intermediate to expert proficiency in Excel Preferred Qualifications: * MBA, CISA, CPA or similar credentials * Public accounting experience * Healthcare Industry experience * Experience with systems implementations * Beginner level SQL or SAS coding * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** . As a Senior Financial Project Manager supporting the E&I accounting team, your primary duties will be a combination of Project management, systems, integration, and accounting/finance work. The successful candidate will need an understanding of the systems that support our financial reporting and an understanding of the data flows surrounding those systems. You'll need to partner/collaborate with our E&I accounting teams, as well as other functions within the organization to ensure successful project implementations, acquisition integrations and accurate documentation of financial processes, data flows and project decisions as they are impacted by various regulatory programs, new product launches or other changes in business. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Gain and maintain a working knowledge of the systems that support our accounting/finance functions + Document key processes and data flows + Develop, document, and implement project communication plans: Ensure clear and effective communication across all project stakeholders, drive decision making, risk mitigation, and concise project summaries with leadership + Work with Accounting/Finance teams impacted by new regulatory programs, products launches, system implementations and serve as a liaison between Finance and IT to develop requirements and to address implementation issues + Work with accounting teams from mergers, acquisitions and/or divestitures to integrate or segregate into UHC financial reporting systems and processes as needed + Develop and maintain relationships across business segments and departments + Develop approaches for continued improvement in efficiency and effectiveness + Serve as a Subject Matter Expert on various projects You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Bachelor's degree with concentration in Accounting or Finance + 5+ years of experience in Accounting/Financial Data Analysis/Accounting Systems + Solid understanding of financial accounting and GAAP + Project management experience with ability to manage end to end project execution from initiation to completion with strong current state/future state process mapping + Solid communication skills with the ability & confidence to drive discussions to conclusion/decisions on topics and the ability to summarize & document these decisions for leadership + Self-starter with excellent organizational skills and attention to detail + Experience with large volume data analysis + Intermediate to expert proficiency in Excel **Preferred Qualifications:** + MBA, CISA, CPA or similar credentials + Public accounting experience + Healthcare Industry experience + Experience with systems implementations + Beginner level SQL or SAS coding *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. This job is responsible for definition, planning and delivery of complex programs that require cross-functional collaboration and management of interdependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget. Includes the management of a group of internal exempt and/or matrixed employees and contractors that serve on the program(s) to deliver solutions for the business. **ESSENTIAL RESPONSIBILITIES** + Works with business and technical organizations to drive out program strategy and approach. Organizes, plans, and maintains Program roadmap consisting of cross-functional activities/projects. + Work with business and technical organizations to assemble project teams. Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program. + Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives. Acquire understanding of the business objectives for an assigned area." + Monitor, evaluate and report on Program status inclusive of scope, schedule, budget and alignment to Program and strategic goals. Direct corrective action as needed to maintain the viability of the Program. + Develop and maintain positive customer relationships. Deliver presentations of project status to effectively communicate throughout the project lifecycle. + Adhere to Highmark project management methods, project lifecycle methodologies, and audit requirements. Support and contribute to the improvement of project management methods and practices. + Other duties as assigned or requested. **EDUCATION** **Minimum** + High School Diploma/GED **Preferred** + Bachelor's degree **EXPERIENCE** **Minimum** + 1 - 3 years experience in a project manager role and/or in a project leadership role **Preferred** + Health Care Insurance industry business and operational knowledge + Experience with an industry standard software development lifecycle **LICENSES/CERTIFICATIONS** **Required** + None **Preferred** + PMP certification or equivalent training **SKILLS** + Experience with customer relationship management + Presentation skills + Negotiation skills + Experience with conflict resolution + Experience with Risk Mitigation Planning + Team Building Skills + Strong interpersonal skills + Very good verbal and written communication skills + Solid organizational and planning skills + Solid leadership skills **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $57,700.00 **Pay Range Maximum:** $107,800.00 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J269709