Role: Project Manager/ Capability Manager
Location: Remote
Duration:12+ Months
Description:
The Enterprise Claims Capability Manager (Project Promise Gold Carding Initiative) is responsible for working with Claims Business Partners to develop requirement capabilities for this complex claims-impacted initiative. Define the business' needs and wants and collaborate closely with the Strategic Domain Product Owner, Architecture Teams and IT Support to determine Solution Intent. Manage capabilities across the delivery lifecycle while broadly applying a prioritization framework. Establish lasting relationships with relevant business teams for strategic alignment. Manage capabilities related to defined cost/benefit, business value, and service. Drive engagement with technology or operations on requirements and approach for desired business outcome.
Project Promise Gold Carding Initiative Overview: Gold Carding is a term used to describe an exemption rewarded to care provider groups who have demonstrated consistent adherence to medical policies and evidence-based guidelines for individual state and national prior authorization requirements. Beginning October 1st of 2024, care provider groups that meet eligibility requirements and practice within the guardrails of evidence-based medicine will be approved for the UHC Gold Card program across all lines of business. Business process and system enhancements are required to support this effort up-to and following the October 1st deadline. The Enterprise Claims Capability Manager role will support this effort across multiple lines of business and multiple claims platforms.
What does the team make-up look like how many members and what is the break-down of the team's skill sets (ex: 1 PM, 4 Developers, etc.)? This CM role will be included in my organization of Capability Managers (7). The specific Project Promise Enterprise Capability Manager role would support multiple claims applications. Each application has their own Agile delivery team, which is typically comprised of Product Owner, Engineers, and QE/QA Leads. Currently, the claims applications involved in this program include UNET, USP, COSMOS, NICE, CSP Facets, and CCAM.
Primary Responsibilities:
Supports capability vision, strategy, priority and roadmap; engage appropriate enterprise-wide stakeholders to enable awareness and alignment.
Demonstrates deep understanding of relevant business and/or product strategies.
Successfully defines capabilities and accepts functionality reviews.
Partners with stakeholders to gather, document and groom business requirements, enable successful prioritization, development, delivery, and adoption of capabilities using a defined development process.
Ensures health of capabilities are reported timely and accurately.
Mitigates, manages, and resolves risks and issues associated with capability delivery.
Demonstrates awareness of defined business value.
Supports initiative issue resolution and annual provider re-qualifications.
Serves as the capability champion and applies expertise to credibly represent, manage and engage with business and IT stakeholders to achieve business objectives and expectations.
Minimum Qualifications:
Intermediate or greater level of proficiency with Excel, PowerPoint, Word, and Visio
3+ years of project management/capability management, business analysis, and/or product management
Proven experience in successfully managing one or more major projects across multiple business areas or systems
2+ plus years facilitating workgroups
Demonstrated experience with process improvement, workflow, benchmarking, and/or evaluation of business processes
Demonstrated experience in gathering and evaluating requirements and also writing and translating business requirements
Experience working directly with senior level business stakeholders
Solid working knowledge of how to execute on project deliverables in a fast-paced environment
Preferred Qualifications:
Healthcare Industry experience preferred
Prior UHG/Optum experience preferred
COSMOS, NICE, CSP Facets, UNET or USP platform experience is a plus or other Medical Claims System experience
Prior experience with Agile methodology preferred
Prior experience with Rally and Aha! delivery and roadmap tools preferred
2 years prior experience with development tools, task plans, milestone charts, and status reports preferred
Ability to develop strong networks and ensure collaboration and consensus-building
Ability to communicate complex issues to diverse audiences
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