Project Manager - Medicaid Provider ManagementLocation: Remote - U.S. (with occasional travel to Harrisburg, PA)Job Overview: We are seeking an experienced, proactive, and execution-focused Project Manager to lead interface and integration activities for the Provider Management Module within the Pennsylvania Medicaid Management Information System modernization program.
This is a high-visibility, multi-year initiative transitioning the Commonwealth's legacy Medicaid systems to a modular, interoperable enterprise architecture. The Project Manager will coordinate the planning, development, testing, deployment, and operational readiness of interfaces connecting the Provider Management Module with other MMIS modules, Commonwealth systems, federal data sources, and external partners.
The successful candidate must be more than a schedule and status manager. This individual will be expected to take ownership of complex workstreams, anticipate broader program impacts, drive open items through completion, hold multiple parties accountable, and actively resolve issues that extend beyond narrowly assigned responsibilities. The ideal candidate combines disciplined project management experience with knowledge of system integration lifecycles, Medicaid or public-sector healthcare programs, and multi-vendor technology implementations.
Responsibilities:
Interface Lifecycle and Workstream Management- Lead the end-to-end planning, coordination, execution, monitoring, and completion of inbound and outbound Provider Management Module interfaces.
- Coordinate interface activities from initial definition and Interface Control Document development through connectivity, development, testing, deployment, and operational readiness.
- Develop, maintain, and baseline detailed interface delivery schedules, work breakdown structures, milestones, and dependencies aligned with the program's Integrated Master Schedule.
- Track critical-path activities and technical prerequisites across the Provider Management vendor, integration platform teams, MMIS module vendors, Commonwealth teams, and external data partners.
- Drive interface milestones through System Integration Testing, User Acceptance Testing, regression testing, interface mock runs, Operational Readiness Reviews, and production implementation.
- Maintain clear ownership, due dates, dependencies, risks, and completion criteria for all interface activities.
- Ensure that interface work supports the underlying business requirements and intended Medicaid operational outcomes-not only technical connectivity.
Ownership and Execution Leadership- Take responsibility for driving complex assignments and workstreams through completion, including work involving multiple teams with shared or unclear ownership.
- Identify stalled decisions, unresolved dependencies, technical blockers, and delivery risks before they affect critical milestones.
- Develop and execute practical mitigation plans, recovery strategies, and corrective actions.
- Look beyond immediate assignments to identify downstream impacts on other modules, testing activities, business operations, implementation readiness, and CMS certification.
- Follow issues and action items through verified closure rather than limiting involvement to documenting or reporting status.
- Hold internal teams, vendors, and external partners accountable for agreed-upon deliverables, decisions, and dates.
- Escalate issues appropriately and provide project leadership with clear options, impacts, and recommended actions.
Stakeholder and Vendor Coordination- Serve as the primary project management point of contact for Provider Management interface activities.
- Coordinate daily with Commonwealth stakeholders, program leadership, the Provider Management solution vendor, downstream module vendors, integration teams, and external interface partners.
- Organize and facilitate Joint Interface Working Groups, technical walkthroughs, Joint Application Development sessions, planning meetings, and issue-resolution sessions.
- Manage competing vendor priorities and drive consensus when responsibilities or technical approaches are unclear.
- Establish strong working relationships with business, technical, vendor, and executive stakeholders.
- Communicate complex interface dependencies, delivery risks, and technical issues clearly to both technical and non-technical audiences.
- Diplomatically challenge incomplete plans, unclear ownership, unrealistic dates, or assumptions that could affect program outcomes.
Requirements and Business Alignment- Work with business analysts, technical teams, and vendors to confirm that interface designs remain aligned with approved business and functional requirements.
- Understand Provider Management business processes sufficiently to recognize how interface decisions affect provider enrollment, screening, credentialing, revalidation, provider master data, and downstream Medicaid operations.
- Support traceability among business requirements, interface specifications, development activities, test scenarios, defects, and implementation evidence.
- Identify cross-module impacts involving Claims, Financial Management, Pharmacy, Electronic Visit Verification, Enterprise Data Warehouse and Reporting, Member Eligibility, and other Medicaid enterprise components.
- Confirm that interface testing addresses data quality, reconciliation, exception handling, error processing, operational workflows, and end-to-end business outcomes.
Governance Risk and Issue Management- Maintain comprehensive risk, issue, action, dependency, assumption, and decision logs.
- Track and drive the resolution of interface defects, change requests, action items, and design decisions through established governance processes.
- Perform impact analysis for proposed changes affecting interface scope, schedules, testing, business operations, or related modules.
- Support formal change-control activities and provide clear documentation of schedule, resource, technical, and operational impacts.
- Prepare recovery plans for schedule slippage, missed dependencies, resource constraints, and unresolved technical decisions.
- Ensure risks and issues are escalated with sufficient context, business impact, recommended action, responsible owner, and required resolution date.
Reporting and Executive Communication- Produce accurate, concise, and data-driven status reports covering interface health, milestones, dependencies, testing progress, risks, decisions, and corrective actions.
- Develop and maintain executive dashboards, milestone reports, critical-path analyses, readiness assessments, and testing metrics.
- Translate detailed technical information into clear executive-level summaries.
- Present emerging risks and recommended actions to program leadership before they become delivery problems.
- Maintain accurate meeting documentation, decision records, and closed-loop action-item tracking.
CMS Certification and Operational Readiness- Coordinate documentation, traceability, testing results, and operational evidence supporting applicable CMS certification requirements.
- Work with business, technical, testing, and certification teams to confirm that required interface evidence is complete, consistent, and available for review.
- Support implementation planning, operational readiness, production cutover, transition, and post-implementation stabilization activities.
Required Qualifications:
- Bachelor's degree in Business Administration, Information Systems, Computer Science, Health Informatics, Project Management, or a related field.
- Active Project Management Professional certification in good standing.
- At least four years of structured IT project management experience leading system implementation, integration, or modernization projects involving multiple stakeholder groups.
- Demonstrated experience personally owning and driving complex workstreams from planning through implementation and closure.
- Experience supporting Medicaid Management Information Systems, Medicaid Enterprise Systems, state health and human services programs, or comparable large-scale healthcare technology initiatives.
- Direct experience coordinating system interfaces and integrations across multiple vendor platforms.
- Working knowledge of REST and SOAP APIs, web services, EDI transactions, SFTP or batch exchanges, and enterprise data-integration pipelines.
- Strong understanding of the Systems Development Life Cycle, Agile and Waterfall delivery methods, and testing phases including Unit Testing, System Integration Testing, User Acceptance Testing, regression testing, and interface mock runs.
- Demonstrated experience managing integrated schedules, critical-path dependencies, risks, issues, action items, decisions, defects, and change requests.
- Proven ability to facilitate technical and business discussions involving state stakeholders, vendors, developers, architects, business analysts, testing teams, and executive leadership.
- Strong written communication, presentation, facilitation, negotiation, and conflict-resolution skills.
- Ability to operate independently, manage ambiguity, challenge assumptions constructively, and drive work through completion with limited supervision.
Preferred Qualifications:
- Seven or more years of IT project or program management experience.
- Experience supporting a large-scale state Medicaid modernization initiative.
- Experience working from a state agency, client advisory, program management, quality assurance, or independent oversight perspective.
- Familiarity with Medicaid Provider Management or Provider Enrollment and Screening solutions.
- Understanding of provider enrollment, credentialing, screening, revalidation, ownership disclosure, provider master data, and program integrity processes.
- Experience coordinating Provider Management interfaces with Claims, Financial Management, Pharmacy, Electronic Visit Verification, Member Eligibility, Enterprise Data Warehouse and Reporting, or other Medicaid modules.
- Experience with National Plan and Provider Enumeration System, OIG or LEIE, licensing boards, financial institutions, managed care organizations, or other provider-related external interfaces.
- Exposure to healthcare interoperability standards and frameworks, including HIPAA EDI transactions, HL7, FHIR, and MITA.
- Experience supporting CMS certification, operational readiness, implementation planning, or production cutover activities.
- Experience recovering a delayed or at-risk multi-vendor integration workstream.
Tools and Technology:
Candidates should have experience with:
- Azure DevOps, TFS, Jira, or similar tools for work-item, backlog, defect, and dependency management
- Microsoft Project or a comparable enterprise scheduling tool
- Microsoft Teams, Excel, Word, PowerPoint, Visio, and SharePoint
- Power BI, Tableau, or similar reporting and dashboard tools
- Process-flow, dependency-mapping, and workflow-documentation tools
