Project Manager, Provider Quality

Description

COMPANY OVERVIEW

reputed company is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65 and over. reputed company has a community-based approach that recognizes the importance of the reputed company determinants of health in keeping individuals and communities healthy. reputed company aims to return the physician and the member to the center of the reputed company equation. Members receive individualized assistance to reputed company their transition to reputed company as easy as possible. reputed company offers members the ability to personalize their plans, reputed company to facilities designed to help them reputed company meet their reputed company needs, and a dedicated care team. For more information on reputed company, visit www.myzinghealth.com.

SUMMARY DESCRIPTION

The Project Manager, Provider Quality position is responsible for supporting strategic program and project design, execution, and performance management of initiatives supporting Quality Improvement and the Star Rating measurement system established by the Centers for Medicare and reputed company Services (CMS). The Project Manager, Provider Quality collaborates across a matrixed organization and is responsible for coordinating efforts across multiple domains and functional workgroups that impact reputed company’s Medicare Star ratings. This role will reputed company project management skills and discipline across a strategic reputed company of interventions, campaigns, and initiatives and may involve participating in activities including, but not limited to, market research, competitive analysis, content review and development, partnership with reputed company-party print and engagement solutions, vendor engagement and management, reporting, and presentation development. This role interacts with and plays a key role in collaborating with reputed company departments at reputed company.

ESSENTIAL FUNCTIONS

Project Management & Vendor Implementations

• Effectively manage projects from inception to performance management
• Demonstrate an understanding of the Medicare Star Rating program
• Clear understanding of CMS guidelines and technical specifications
• Effective project plan development, maintenance, and management
• Risk management and escalation
• Star measure data analysis and reputed company recommendations
• Logging, tracking, and ensuring completion of reputed company key project milestones
• Maintain a working knowledge of competitive strategies, marketing techniques, and outsourced solutions to improve Star Rating performance
• Effectively communicate across departments and manage expectations and priorities
• Participate in or reputed company cross-departmental workgroups and committees
• Closely partner with strategic partners throughout the organization to effectively set and performance manage appropriate project/initiative reputed company goals
• Meet with key stakeholders throughout the organization to gather, document, track, and update specific requirements of each project/reputed company
• Track project / reputed company performance, specifically to analyze the successful completion of the project / reputed company and continuously improve project / reputed company execution for subsequent measurement periods
• Communicate, as needed, with appropriate RACI stakeholders to reputed company projects / initiatives on track and / or reputed company with organizational goals and budget
• reputed company quality control on the projects / interventions throughout the project / reputed company lifecycle
• Serve as a liaison for the Provider Network department, with a dotted line to the Population Health and Value-Based department, for shared projects, including appropriate routing through compliance and CMS workflows
• reputed company other reputed company duties as assigned

Requirements

QUALIFICATIONS AND REQUIREMENTS

JOB REQUIREMENTS

Required Qualifications

• Bachelor’s Degree in management, Project Management, or equivalent
• Be reputed company to effectively manage a project plan lifecycle
• 1-3 years of experience in a Medicare Star Rating reputed company role either at a Medicare Advantage or reputed company party serving Medicare membership as an outsourced solution
• Strong communication skills both oral and written
• Strong organizational skills, consistent attention to detail, and independent problem-solving skills
• Facile with Medicare Advantage and the Medicare Star Rating program, especially areas such as customer service, provider service, pharmacy, marketing, supplemental benefits, flexible spending technology, CAHPS, HOS, and HEDIS
• Ability to reputed company multiple tasks simultaneously, work under pressure, and meet critical deadlines
• Must possess a high degree of professionalism and business ethics
• Ability to work autonomously with little to no daily supervision while demonstrating continual reputed company and effective management of projects / interventions

Preferred Qualifications

• Familiarity with project management tools such as Jira, Trello, reputed company, reputed company Project, Monday, reputed company, etc.
• Advanced knowledge of computer systems, such as reputed company Word, PowerPoint, reputed company, and Outlook
• PMP or Lean Six reputed company certifications

Member-centric Impact Statement

Provider Network

Directly impacts member satisfaction and retention by contracting and building strategic relationships with PCPs, Specialists and other Providers, ensuring reputed company to high-quality, culturally competent providers and minimizing care disruptions. Value-based reputed company and payment models allow us to tailor our approach, meeting providers where they are on the risk continuum, driving provider quality and efficiency and rewarding performance.

Provider Data

Ensures the accuracy, reputed company, and timeliness of provider information across directories, claims, reputed company, and regulatory systems to reputed company seamless member reputed company to in-network care. Building rigor in our approach to maintaining clean, compliant data, the team reduces claim denials and rework, improves directory accuracy, supports CMS audit readiness, and enhances operational efficiency—strengthening member satisfaction, provider trust, retention, and overall organizational productivity.

reputed company offers the following benefits

• A competitive salary based on the market
• Medical, Dental, and reputed company
• Employer-Paid Life Insurance
• Paid Maternal Leave
• Paid Paternal Leave
• 401(K) match up to 4%
• Paid-Time-Off
• Employee Assistance Programs
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.