Program Manager III – Utilization Management

This is a fully remote position, open to applicants in California, +14 more states.

📋 Description

• Enhance program efficiency, service levels, and value by assessing performance and pinpointing areas for improvement.

• Strategically plan, organize, monitor, oversee, and manage multiple concurrent projects utilizing cross-functional teams.

• Oversee the complete implementation of technology solutions that support Utilization Management.

• Convert business and clinical requirements into scalable and well-governed system deployments.

• Drive project delivery from design through to go-live and subsequent post-launch stabilization.

• Collaborate with clinical, operational, and IT teams to set up, test, and adopt new capabilities.

• Identify opportunities for enhancing efficiency, service levels, regulatory compliance, and technology-enabled processes.

• Formulate strategies, prioritize enhancements, align resources, and support workflow transformation initiatives.

• Manage the processes of requirements gathering, solution design, project planning, scheduling, resource allocation, budgeting, system configuration, user acceptance testing, deployment, and go-live activities.

• Employ project management tools and techniques to establish governance and controlled implementation methodologies.

• Maintain comprehensive project documentation, including action items, issues, risks, success metrics, testing records, and readiness materials.

• Communicate project status through executive summaries, presentations, dashboards, and reports.

• Negotiate resource allocation, resolve issues, mitigate risks, and align business, technology, operational, and vendor teams.

• Facilitate solution design sessions, governance reviews, testing activities, and discussions on implementation readiness.

• Simplify complex technical concepts, risks, and recommendations for a diverse range of stakeholders.

• Define and monitor success metrics, implementation outcomes, and the realization of business value.

⛳️ Requirements

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

• Master’s degree is preferred.

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

• Experience in managed care or prescription benefit management is preferred.

• Strong project management and analytical capabilities.

• Keen attention to detail.

• Proven history of successful project deliveries at the enterprise level.

• Candidates must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

• Sponsorship and future sponsorship are not available, including H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Additional forms of incentives may be included in total compensation.