Project Manager -IT Medicaid Healthcare

About the role

We are seeking an experienced IT Healthcare Consultant Project Manager to lead operational management and support activities for Medicaid Management Information System (MMIS) environments and related healthcare systems. The consultant will lead cross-functional teams responsible for business-critical operations, including managed care organization (MCO) enrollment, claims and encounter processing, payment operations, production support, helpdesk activities, interface/EDI support, stakeholder monitoring, and user acceptance testing. This is a fast-paced environment requiring strong project management, healthcare systems, operational support, vendor management, incident management, and stakeholder communication skills.

Responsibilities

• Oversee, coordinate, and perform operational and production support activities for MMIS, encounter processing systems, and supporting applications.
• Coordinate with vendors and internal technical teams, including cybersecurity and enterprise architecture functions.
• Manage vendors and monitor contractual service-level agreements (SLAs).
• Design and develop desk aides, process documentation, and operational workflows for new and existing service lines.
• Train team members on desk aides, process flows, ticketing systems, and operational support procedures.
• Lead and motivate diverse teams supporting production operations, helpdesk functions, interface/EDI support, stakeholder monitoring, and user acceptance testing.
• Oversee incident and issue management, including documentation, tracking, escalation, and resolution.
• Ensure timely resolution of production issues and operational incidents.
• Identify operational risks and issues and coordinate appropriate mitigation activities.
• Manage internal and external escalations and ensure requests and issues are resolved effectively.
• Ensure work is appropriately assigned and escalations are addressed in a timely manner.
• Monitor compliance with applicable healthcare and government security requirements and ensure findings and recommendations are addressed through completion.
• Promote a safe, professional, productive, and engaged team environment.
• Implement and monitor Standard Operating Procedures (SOPs) and identify deviations from established processes.
• Oversee release management activities, including stakeholder communications, pre-implementation planning, readiness assessments, and post-implementation monitoring.
• Support change management through backlog grooming, backlog maintenance, and adherence to appropriate approval processes.
• Prepare reports and presentations for technical, operational, and executive-level stakeholders.
• Provide guidance to team members and oversee workload assignments.
• Maintain strong documentation and process management practices.

Requirements

• Bachelor’s degree in a technical, business, healthcare, or related field. Alternatively, 5+ years of equivalent experience in business/systems analysis and/or computer systems development or modification may be substituted.
• 3+ years of experience managing system operations and/or administrative program functions within a healthcare environment.
• 5+ years of project/program management experience, including management of system implementations or enhancements.
• Experience providing or supporting incident management and after-hours/on-call operations.
• Strong ability to manage workloads, assign responsibilities, and provide direction to technical and operational teams.
• Excellent communication skills with audiences ranging from frontline staff to executive management.
• Strong documentation, process management, and organizational skills.
• Knowledge of the systems development lifecycle (SDLC).

Preferred Qualifications

• Experience managing operations for Medicaid enterprise systems.
• Knowledge of Medicaid eligibility, enrollment, and MMIS concepts.
• Experience with ticketing/service management software.
• Experience developing and documenting SOPs for new system implementations.
• Experience preparing management reports and delivering presentations.
• AWS Cloud certification(s).

Key Competencies

• Project and program leadership
• Healthcare IT operations
• Incident and issue management
• Vendor and SLA management
• Release and change management
• Team leadership and workload management
• Process documentation
• Stakeholder communication
• Production support
• Operational risk and issue mitigation
• Ability to work in a fast-paced environment
• Ability to support occasional after-hours operational needs