Project Manager

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee the operations of third-party vendors, ensuring compliance with SOW, conducting medical record abstraction, performing quality reviews, and managing special projects in line with NCQA Technical Specifications.

• Supervise the calibration of both offshore and onshore record review practices, which include training, testing, abstraction, and documentation for HEDIS measures.

• Create and uphold vendor processes related to medical record intake, align workflows, and report results to healthcare providers.

• Assist in coordinating compliance and privacy negotiations involving vendor processes, record access, and operational workflows.

• Generate, revise, and maintain documentation, training materials, and standard operating procedures.

• Track vendor SOW compliance, analyze intake and abstraction data, and provide regular reports and updates to leadership.

• Collaborate with the Vendor Management Organization on SOWs, RFPs, staffing models, financial considerations, and long-term workload projections.

• Organize offshore staffing activities, which encompass onboarding reviews, background checks, Workday profile setup and updates, and staff transfers.

• Work alongside Quality Management teams, Stars market partners, Engagement Managers, RN/PM specialists, and other stakeholders to ensure audit readiness, address research requests, manage special projects, and evaluate abstraction outcomes.

⛳️ Requirements

• A minimum of 3 years of robust experience with HEDIS measures and a solid understanding of HEDIS technical specifications.

• At least 3 years of experience in managing HEDIS-related operations, medical record abstraction, quality review, or similar healthcare quality initiatives.

• A minimum of 2 years of vendor management experience or a comparable background.

• Capability to analyze data, support reporting efforts, and ensure data integrity.

• Excellent organizational skills with the ability to handle multiple priorities in a dynamic environment.

• Experience in collaborating with both internal and external stakeholders to enhance operational execution and process improvement.

• Strong written and verbal communication abilities.

• Proficiency in Microsoft Office suite, including Excel, PowerPoint, and Word.

• Availability to work EST due to the areas covered.

• Background in project management within a vendor, healthcare, quality, or operational setting.

• Proven experience leading cross-functional projects that involve vendors, data processes, and operational execution.

• Familiarity with medical record exchange technologies, repository vendors, or regulated data workflows.

• PMP certification or formal project management training is preferred.

• Bachelor’s Degree or Equivalent is required.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources supporting physical, emotional, and financial well-being

• Eligibility for CVS Health bonus, commission, or short-term incentive programs