Job Details

Group Medicare Project Manager, Senior

The Group Medicare team is responsible for Client & Stakeholder Management, Retiree & Member Support Operations, Project Management & Execution, Compliance, Quality, & CMS Readiness, Data, Reporting & Continuous Improvement. In this role, you will support the delivery and operational excellence of our Group Medicare offerings. You will coordinate cross-functional workstreams, collaborate closely with internal teams and external employer groups, and help ensure a seamless experience for both clients and members. Your work directly supports the retiree populations we serve and strengthens the overall performance and growth of our Group Medicare business. The Project Manager, Senior Group Medicare will report to the Program Manager.

The Group Medicare team serves retirees both inside and outside of California. We partner with employer groups and plan sponsors to offer Medicare Advantage and Medicare Part D solutions tailored to their retiring employees and eligible dependents. This role plays a key part in ensuring those clientsand their retireesreceive high-quality support throughout the plan lifecycle.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

In this role, you will:

• Direct small-scale, complex programs/projects that may involve multiple internal and external stakeholders
• Manages the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
• Monitors the program from initiation through delivery and monitors for continuous improvement across projects within program
• Organizes the interdepartmental activities ensuring completion of projects within the program are on schedule and within budget
• Interfaces with internal and external customers on technical matters and program status
• Responsible for assembling a project team, assigning and monitoring work of team members and providing guidance and leadership
• Develop the program, integrated program plan, resource plan, contingency plan, and related project management artifacts
• Evaluate trade-offs between program size and complexity, cost, urgency, risk, and stakeholder value
• Validate financial forecasts and provide on-going reconciliation of resources and other related program expenditures
• Partner with business sponsors to define success metrics and criteria
• Assess and resolve all high priority program risks as they are encountered
• Ensure all projects adhere to project methodology compliance standards set by the company
• Serve as a subject matter expert to regularly brief key stakeholders on different aspects of assigned initiatives
• Represent the program in various project governance and inter-departmental forums
• Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
• Manage operational and client-facing activities for the Group Medicare retiree line of business, ensuring smooth execution of implementations, annual readiness cycles, and ongoing plan updates
• Coordinate cross-functional teams to support accurate retiree enrollment processing, member communications, issue resolution, and alignment with CMS requirements
• Monitor Group Medicare performance trends and escalations, partnering with internal teams to drive improvements in service, compliance, and the overall retiree experience
• Other duties as assigned

Qualifications

Your Knowledge and Experience:

• Requires a bachelor's degree or equivalent experience
• Requires at least 5 years of prior relevant experience
• Requires experience with project management methodologies, tools, and best practice
• Requires experience within healthcare, managed care, or health plan operations
• Experience working on Group Medicare Advantage products strongly preferred
• Lean Six Sigma Green Belt or Black Belt certification (or equivalent process improvement training) with demonstrated ability to apply structured problem-solving and process optimization techniques strongly preferred
• Strong understanding of CMS requirements, compliance standards, and annual readiness cycles
• Demonstrated experience leading cross-functional initiatives involving multiple internal and external stakeholders

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.