Resp & Qualifications
PURPOSE:
As an IT Project Manager Regulatory Operations & Mandates this role is responsible for leading the planning and delivery of projects driven by state, federal, and industry regulatory requirements. This role serves as a key liaison between Legal, Regulatory Operations, IT, and business stakeholders to translate regulatory mandates into actionable business and technical requirements.
This position will scope and manage mandate-driven initiatives across Commercial and Government Programs, ensuring compliance obligations are integrated into project delivery. This role is accountable for providing the operational compliance requirements and oversight to multiple projects of varying complexity throughout the full project lifecycle, from initiation and kickoff through implementation and closure, ensuring all regulatory requirements are met and maintain proper documentation of compliance.
ESSENTIAL FUNCTIONS:
Regulatory Intake, Analysis & Scope Definition
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Translate legal interpretations of regulatory requirements into business and system compliance requirements.
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Analyze impacts across products, funding types (Commercial, ASO, Government Programs), and operational areas.
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Identify impacted stakeholders, systems, and processes to define project scope and requirements.
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Partner with Legal and business teams to clarify requirements and resolve interpretation questions.
Project Planning & Execution
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Track and monitor regulatory milestones and effective dates throughout the project lifecycle
In conjunction with the ePMO PM, develop and manage project plans, timelines, deliverables, and resource allocation. -
Ensure regulatory and business requirements are fully integrated into project scope and facilitate a detailed handoff to ePMO to initiate execution phase.
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Monitor risks, issues, and dependencies, with a focus on compliance and operational impact.
Cross-Functional Leadership & Stakeholder Management
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Serve as liaison between Regulatory Operations, Legal, IT, and business stakeholders.
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Lead cross-functional discussions to align implementation approach, requirements, and timelines.
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Provide regulatory guidance to project teams and influence decision-making.
Governance, Financials & Reporting
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Ensure compliance documentation and audit-ready evidence is completed and maintained in tracking system/site.
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Provide regular project status updates and reporting to leadership.
- Support regulatory reporting efforts, including ad hoc and complex reporting requests, by partnering with Lead Reporting Analyst, as needed, to ensure accuracy, completeness, and alignment with regulatory requirements.
SUPERVISORY RESPONSIBILITY:
This position has no direct reports, however, may informally lead teams in a matrix environment.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Health Informatics, Information Technology, Information Systems or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Licenses/Certifications Preferred:
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Certified Project Management Professional (PMP)-PMI.
- SAFe Scrum Master Certification.
Experience: 3 years experience leading projects in a cross-functional, technical systems implementation.
Preferred Qualifications:
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Experience interpreting or operationalizing state and federal healthcare laws/regulations.
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Knowledge of Commercial and Government Programs (e.g., Medicare, Medicaid, FEHBP).
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Experience translating regulatory or legal requirements into business and technical solutions.
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Experience working within an EPMO or supporting system implementations.
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Familiarity with health plan operations (e.g., benefits, claims, provider, enrollment).
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Experience supporting regulatory compliance initiatives or audits.
Knowledge, Skills and Abilities (KSAs)
- Strong Financial Management ability including comprehension of project financials, profit and loss and the ability to create and manage and adhere to a broader project budget.
- Strong Communication skills both written and verbal.
- Ability to successfully lead in a matrixed environment.
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Strong understanding of regulatory compliance and ability to translate regulatory requirements into operational and technical solutions.
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Ability to manage multiple projects simultaneously with competing deadlines and regulatory time constraints.
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Proficiency in project management methodologies.
- Strong analytical and problem-solving skills, including the ability to assess impacts across systems and business areas.
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Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $89,856 - $178,464
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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