Quality Project Manager Medicaid Job at CVS Health (Work at Home)

Senior Medicaid (MMIS) Project Manager

The Senior Medicaid (MMIS) Project Manager will lead the modernization of the Il...

Location

United States , Springfield

Salary:

94166.00 - 145000.00 USD / Year

NTT DATA

Expiration Date

Until further notice

Requirements

Project Management Professional (PMP) certification
Bachelor’s degree and eight to ten (8-10) years of progressive experience and possess extensive knowledge when advising on large and high complex project/programs
Minimum of five (5) years of experience providing complex acquisition management or program/project management support services, including experience with public sector or government contracts
Minimum five (5) years working on Medicaid Management Information System (MMIS) or Medicaid Enterprise Systems (MES) projects
Minimum three to five (3-5) years supervising work product delivery from a team and coordinating service delivery
Minimum 3 years using Microsoft Project
Ability to obtain and maintain any required security clearances or certifications as specified in the contract
Extensive experience preparing for and facilitating meetings, interviews, presentations, and training sessions, as well as maintaining related documentation
Strong knowledge of project management methodologies, tools, and best practices
Proven leadership skills with the ability to motivate and manage cross-functional teams

Job Responsibility

Lead and manage the delivery of all services and activities listed in the task order
Oversee the development, review, and timely submission of all required deliverables
Develop, maintain, and manage detailed project plans, schedules, budgets, communication plans, risk logs, and issue logs
Ensure all internal and external project communications and reporting are occurring
Provide thorough review and quality assurance of project deliverables
Establish and enforce appropriate governance structures and project quality standards
Follow and manage processes for change management, cost tracking, and risk management
Assign tasks, supervise, and coordinate internal staff and subcontractors
Manage client relationships and expectations
Provide recommendations to the client on critical business and project decisions

What we offer

medical insurance
dental insurance
vision insurance with an employer contribution
flexible spending or health savings account
life and AD&D insurance
short and long term disability coverage
paid time off
employee assistance
participation in a 401k program with company match

Fulltime

Senior Analyst

ATI Advisory is seeking a high-performing Senior Analyst to join our project man...

Location

United States , Washington, DC

Salary:

Not provided

ATI Advisory

Expiration Date

Until further notice

Requirements

3+ years of experience in project management roles, preferably in strategy consulting, management consulting, corporate strategy, or equivalent roles
Project Management Professional (PMP) certification with a strong knowledge of project management lifecycle and frameworks
Expertise in healthcare (Medicaid and/or Medicare)
Excellent written and verbal communication skills
ability to craft clear, compelling narratives and present to senior leadership or clients
Strong attention to detail, including the ability to work efficiently to produce accurate and high-quality deliverables
Ability to solve problems independently, manage multiple priorities, pivot quickly based on client needs, and work with incomplete information
High level of professional maturity, initiative, resourcefulness, and growth orientation
Bachelor’s degree

Job Responsibility

Lead project management components of large, complex, and fast-moving projects in close partnership with project leads, with accountability for planning, timelines, budgets, workflows, and delivery health
Maintain high standards of quality, manage multiple projects simultaneously, and operate with a sense of urgency and ownership
Establish and maintain clear project plans and workflows, ensuring teams consistently use ATI’s project management tools and standards
Manage up, down, and across the team and plans proactively to anticipate resource needs and meet project timelines, elevating issues with proposed solutions
Collaborate with senior leaders to grow ATI’s project management practice, including developing and implementing additional project management best practices and standards
Supports proposal development to ensure submissions are well-organized, polished, and submitted on time

Senior Analyst: Consulting - Growth & Innovation

ATI Advisory is seeking a high-performing Senior Analyst to join our Growth & In...

Location

United States , Washington, DC

Salary:

Not provided

ATI Advisory

Expiration Date

Until further notice

Requirements

3+ years of experience in strategy consulting, management consulting, corporate strategy, or equivalent roles
Expertise in healthcare (Medicaid and/or Medicare)
Demonstrated ability to perform market research, competitive analysis, financial modelling, business case development, and strategic growth planning
Strong quantitative and qualitative analytical skills
Excellent written and verbal communication skills
Confidence working with senior executives and contributing to proposals and thought leadership
Ability to manage multiple projects and priorities, work autonomously and cross-functionally
High level of professional maturity, initiative, resourcefulness, and growth orientation
Bachelor’s degree

Job Responsibility

Provide Direction & Build Company Assets
Collaborate with the VP of Strategic Initiatives and executive sponsors to define and drive the ATI’s growth agenda
Build and maintain market intelligence tools
Analyze Medicaid and Medicare ecosystems and map supporting services that operationalize healthcare
Lead market scans, competitive landscape analyses, and opportunity assessment for go-to-market insights
Map key stakeholders, regulatory and policy drivers, value chain shifts, and growth levers in target markets
Monitor ongoing market developments, regulatory changes, policy shifts, and competitive moves
Test & Evaluate Market Strategies
Partner with internal teams to support go-to-market strategy, product/solution ideation, and new business development
Develop recommendations and support implementation planning for new business initiatives, partnerships, offerings, or business models

New

QM Nurse Consultant

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Richmond

Salary:

60522.00 - 129615.00 USD / Year

CVS Health

Expiration Date

March 11, 2026

Requirements

Licensed Registered Nurse (RN) with an unrestricted Virginia license
Virginia residency required
Minimum 3+ years’ experience in Medicaid managed care, quality improvement, PIPs, or EQRO-related functions
Strong knowledge of Medicaid regulations, DMAS requirements, and CMS EQR Protocols
Proficiency in study design, sampling, data analysis, and quality improvement methodologies (e.g., PDSA)
Excellent communication skills, with experience engaging providers and presenting findings to leadership or stakeholders
Strong project management skills and proficiency in Excel, PowerPoint, and data analysis tools
Associates or diploma nursing degree required

Job Responsibility

Conduct on‑site and desk audits to ensure services comply with DMAS regulations, Medicaid policy, service limits, medical necessity requirements, and provider qualifications
Review medical records, billing patterns, and service documentation to assess compliance and identify inconsistencies or potential fraud
Analyze utilization trends and exception reports to identify outliers or inappropriate billing practices
Lead provider engagement activities, including documentation requests, exit conferences, and explanation of findings and corrective actions
Prepare accurate audit documentation, summaries, and referrals as needed
Lead validation and evaluation of PIPs in clinical & non-clinical areas per CMS EQR Protocols 3 & 7
Design and refine study topics, aims, populations, sampling methods, indicators, and data collection plans
Conduct statistical analysis on claims, encounter, and survey data
interpret findings accurately
Guide and support market through PIP planning and implementation with best practices and data-driven interventions

What we offer

Affordable medical plan options
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Fulltime

Program Manager with Medicaid

The person in this position is responsible for engaging Program Management and B...

Location

United States , Columbus

Salary:

Not provided

Ocean Blue Solutions

Expiration Date

Until further notice

Requirements

Conduct end-to-end business analysis for SNAP/Cash, Child Care, and Medicaid eligibility and enrollment systems
Manage system integration initiatives, focusing on interface development, data conversion, and reporting solutions
Review and approve detailed system design documentation (Ohio Benefits Design Documents)
Act as strategic liaison with other Project Managers
Recommend enhancements of the Ohio Benefits Self-Service Portal (SSP)
Promote and manage Business Intelligence (BI) initiatives, utilizing tools such as Cognos and Tableau
Conduct detailed analysis and planning for the integration of IVR and EDMS with Ohio Benefits and also BOTs
Work with other technical project managers to deploy system enhancements
Manage JIRA access and provide guidance on the usage and flow of work requests
Work with Operational Change Management team

Job Responsibility

Engage Program Management and Business Analysis tasks and techniques as a liaison among stakeholders in order to understand the structure, policies, and operations of the Ohio Benefits Program (OB), to recommend solutions that enable the Program to achieve its goals, and to ensure the timely delivery of key program initiatives

New

L2 Project Manager

Location

United States , New York

Salary:

Not provided

GENESYS Consulting Services

Expiration Date

Until further notice

Requirements

Between 4 and 7 years of experience as a Project Manager
Minimum 4 -7 years' experience as a PMO Project Manager and experience working in a PMO supporting Health and Human Services Eligibility system supporting at least one of the following domains: Medicaid, Public Assistance, SNAP, HEAP, or ChildCare with proven experience in data conversion and data modeling, Including working with Legacy systems, ETL teams, and validating data quality.

Project Manager

PM will assist in the statewide implementation and coordination of EPSDT and Tar...

Location

United States , Indianapolis

Salary:

Not provided

Ocean Blue Solutions

Expiration Date

Until further notice

Requirements

Candidate must currently be located in Indiana to be considered for this position.
Coordinate the development and implementation of statewide policy and operational models for EPSDT and TCM service delivery to juvenile justice-involved youth.
Coordinate the internal collaborations for design and oversee a Medicaid delivery model that ensures care continuity 30 days before and after discharge from carceral settings.
Ensure Collaboration with Indiana Department of Correction (IDOC), Department of Child Services (DCS), courts, providers, and Managed Care Entities (MCEs).
Ensure Collaboration on Medicaid Policy for implementation of Section 5121 (CAA 2023).
Assist state with the 1115 waiver preparation, or other CMS deliverables as needed.
Ensure all activities comply with CMS EPSDT and TCM requirements and are audit-ready.
Develop workflows that connect juvenile facilities, managed care, behavioral health, and primary care services.
Establish mechanisms for referral, enrollment, and follow-up during the pre- and post-release periods.
Ensure implementation of trauma-informed, culturally competent care planning models.

Job Responsibility

Strategic Program Oversight
Policy & Compliance
Care Coordination & Systems Integration
Data, Quality, & Evaluation
Stakeholder Engagement & Technical Assistance

Nc Medicaid Consultant

World Relief Durham is seeking proposals for a Lead Consultant to assist with ef...

Location

United States , Durham

Salary:

Not provided

Latino Memphis

Expiration Date

Until further notice

Requirements

Medicaid Expertise: Deep knowledge of NC Medicaid managed care, including eligibility criteria, billing codes, and reimbursement rates specific to mental health services for refugees and immigrants (specifically, interactive complexity and other related dynamics)

Job Responsibility

Conduct an in-depth assessment to strengthen World Relief's capacity and program quality
Collaborate with stakeholders to define specific goals and priority areas, assess the organization's viability for Medicaid managed care integration, and draft a detailed timeline and phased implementation plan
Identify and collaborate with key stakeholders (e.g. NC Medicaid, Alliance Health)
Draft a strategic plan tailored to the specific needs of the organization, outlining goals, priority areas, and a phased implementation timeline
Conduct a thorough review of contracts, job descriptions, policies, procedures, workflow processes, communication structures, IT systems, reporting mechanisms, program management, billing procedures, and specialty services
Provide holistic training for staff in critical areas such as workflow assessment, communication, IT systems, reporting, program management, and billing to ensure compliance and best practices
Lead the collaboration with stakeholders to identify goals and priority areas
Conduct analysis to assess World Relief’s current capacity and benchmarks to meet
Develop a detailed timeline and phased implementation plan
Craft a project schedule that outlines tasks, dependencies, and milestones to ensure a structured approach to the implementation process

Quality Project Manager Medicaid

CVS Health

Location:
United States , Work at Home

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 22, 2026

Expiration:
February 27, 2026

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