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J190029

Client Project Manager: Mandates and ACA SME

HM Health Solutions

  • Company Innovative Technology Based Solutions
  • Home, PA
  • Project_Management
  • Full time
  • Day (United States of America)

Company :

HM Health Solutions

Job Description : 

JOB SUMMARY

This job will lead large scale projects or a collection of smaller related projects as a program. Incumbent will manage the overall coordination for the different individual projects in the program as well as ensuring that risks and issues are coordinated across the various projects. Will provide mentorship to other team members. May also be engaged in critical efforts to help correct issues with a challenged project or a large scale client engagement. In some cases, the incumbent will be expected to travel to customer sites to help develop project plans and deliver projects. Responsible for the successful completion of the project on time, on budget and with high quality. Programs will be delivered using Agile Methodologies as defined by the Delivery Excellence processes.

HMHS is contractually obligated to provide and maintain a platform that is compliant with all federal, state, regulatory, and BCBSA requirements. To ensure all plans are able to operate in a compliant fashion while on the HMHS platform, it is paramount that there is a centralized team to facilitate and oversee all aspects of mandate project implementation. This role would also be matrixed to the HMHS Compliance team and would report on mandate project status, raising risks, and mitigating partner plan compliance concerns. This role also includes managing all ACA business on the platform, acting in a SME capacity for all aspects of ACA line of business, including production fixes, mandate and non-mandate projects, and assisting B&E in determining appropriate end-to-end technical solutions that are in line with ACA requirements and standards.  

Overall responsibilities for Mandates oversight:

  • Engage all partner plans in mandate project and enhancement work where it impacts them
  • Ensure that all required mandate governance rules are followed through project delivery
  • Train HMHS Project Managers (PMs) assigned to mandate projects on the specific mandate delivery requirements
  • Manage compliance escalations within all mandate projects (e.g. Differences in interpretation, compliance go to market date disputes, scope of work differences, etc.)
  • Act as a single point of contact (POC) for HMHS PMs for your portfolio, as well as all partner plans on any questions or concerns relating to mandate delivery
  • Monitor critical dates and communicating with Compliance when they are at risk
  • Partner with HMHS Compliance team to ensure that capabilities being implemented adhere to the ‘minimum necessary’ rule to gain compliance
  • Manage all partner plan escalations throughout the delivery process, in tandem with the project manager

Overall responsibilities for ACA SME:

  • Act in an overarching ACA SME capacity for the EHS platform
  • Become SPOC for all ACA-related issues and production fixes on the platform
  • Work with Blueprint and Estimation on ensuring our technical solutioning for ACA business meet business and compliance needs
  • Act in a consultative role for our Product areas to ensure technical requirements for ACA business are appropriate and meet business needs
  • Review technical ACA guidance to determine possible platform impacts
  • Provide any needed oversight to any ACA-specific projects, mandated or not.

EDUCATION

Required

  • Bachelor's Degree in Healthcare, Business, Information Technology or related field

EXPERIENCE

Required

  • 7 years with Project delivery
  • 7 years with Client Relationships

Preferred

  • None

LICENSES or CERTIFICATIONS

Required

  • None

Preferred

  • Project Management Professional (PMI)

SKILLS

  • Large Scale Program/Project Management 

    Financial Planning and Management 

    Strong Communication skills 

    Problem Management and Resolution 

    Working in a Matrixed Organization 

    Client expectations management 

Language (Other than English):

None

Travel Requirement:

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Rarely

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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