Program Manager III

This is a fully remote position, open to applicants in New York, +1 more state.

📋 Description

• Lead strategic initiatives aimed at transforming healthcare operations within health plan environments.

• Seek out opportunities to enhance clinical and operational performance, member experiences, healthcare expenses, and adherence to regulatory and contractual standards.

• Oversee multiple initiatives from identifying opportunities and developing business cases to implementation and performance evaluation.

• Collaborate with clinical operations, Medical Economics, Finance, IT, Product, Provider/Network teams, Payment Integrity, and various cross-functional stakeholders.

• Assess healthcare quality, operational efficiency, member outcomes, service delivery, compliance with regulations, and cost performance.

• Spearhead initiatives across Utilization Management, Care Management, Behavioral Health, Long-Term Services and Supports (LTSS), Clinical Operations, and other payer functions.

• Analyze trends in healthcare utilization and costs, pinpoint key drivers and opportunities, create business cases, and set performance metrics.

• Convert healthcare data and operational insights into actionable strategies, project plans, and quantifiable interventions.

• Formulate cost-reduction strategies and facilitate prioritization, alignment among leadership, and resource distribution.

• Oversee projects through all phases including discovery, requirements gathering, planning, implementation, measurement, and transition to operational control.

• Define objectives, milestones, deliverables, dependencies, risks, decision points, performance metrics, governance structures, and documentation.

• Lead cross-functional teams to drive decisions and achieve defined outcomes.

• Transform business and clinical requirements into technology-driven solutions while ensuring effective implementation and user adoption.

• Track performance after implementation, verify achieved impact, and identify ongoing improvement opportunities.

• Report on project status, risks, financial prospects, decisions, and performance to senior and executive leadership.

• Engage with stakeholders to secure resources, resolve challenges, mitigate risks, and ensure progress.

• Stay informed about managed care operations, healthcare trends, regulatory requirements, and Medicaid considerations.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field, or equivalent relevant experience.

• A minimum of 5 years of experience in project implementation, product management, or program management.

• Prior experience in a healthcare payer or managed care organization is strongly preferred.

• Familiarity with Medicaid and/or other government-sponsored health programs is preferred.

• Understanding of healthcare payer operations and the interconnectedness of clinical operations, healthcare utilization, medical costs, quality, regulatory compliance, and financial performance is preferred.

• Experience working with Medical Economics, healthcare analytics, Finance, or similar disciplines is preferred.

• Proven experience leading complex, cross-functional healthcare initiatives is preferred.

• Excellent communication, facilitation, critical thinking, and problem-solving abilities are preferred.

• Project management certification (PMP, PgMP) and/or healthcare-related credentials are preferred but not mandatory.

• Must have authorization to work in the U.S. without visa sponsorship now or in the future.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in the overall compensation package.

• A workplace committed to diversity and equal opportunity.