Project/Program Manager II (Non-IT)

• Location: 100% Remote

• Eligible States: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater NYC), OH, TX, UT, WA (outside greater Seattle), WI

• Shift: 8:00 AM – 5:00 PM PST

• Schedule: Monday to Friday

This Business Analyst will support delegated group reporting and claims tracking for a managed care organization. The position focuses on tracking IPA reports, coordinating communication and education, and ensuring accurate file management for manual data entry. Candidates must possess strong managed care knowledge, especially in Utilization Management (UM) and Claims, and demonstrate effective communication, analytical, and project management skills.

This role is also involved in broader project coordination efforts such as system implementations and process improvements related to health plan operations, Medi-Cal, and commercial insurance.

• Track IPA Reports: Ensure timely and accurate reporting from delegated groups

• Communication & Education: Email and support provider groups with guidance on proper reporting

• File Management: Coordinate with internal teams for accurate manual data entry

• Claims Tracking: Monitor pending claims and educate on resolution processes

• Troubleshooting: Address issues with delegate submissions and reporting accuracy

• Project Coordination:

  • Create and maintain project documentation (plans, schedules, workflow)

  • Lead cross-functional project meetings and updates

  • Act as liaison between internal departments and external partners
     

• Required: Bachelor’s Degree

• Not Required

• 2–5 years of experience in Managed Care

  • Knowledge of UM, Claims, and IPA Reports

  • Experience with CA-based insurance programs (Medi-Cal, Commercial plans)

• 2–4 years of Project Management or Systems Implementation experience

• Proficient with Microsoft Excel, Word, PowerPoint, Project, and Visio

• Strong verbal and written communication skills

• Ability to multitask and manage large-scale projects

• Experience in:

  • Claims auditing, Compliance analysis, or Business analysis in a healthcare setting

  • Collaborating with internal departments and Health Plans

  • Educating provider groups and troubleshooting reporting issues