Program Manager III - Utilization Management

Position Purpose: Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities. Plan, organize, monitor, oversee and lead multiple, concurrent resultant projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives.
Key Details: This exciting remote opportunity focuses on leading the end-to-end implementation of technology solutions supporting Utilization Management, translating business and clinical requirements into scalable, well-governed system deployments. This role acts as the implementation manager driving delivery from design through go-live and post-launch stabilization, partnering across clinical, operational, and IT teams to ensure new capabilities are configured, tested, and adopted successfully. This is a remote position within the United States. Candidates must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

• Identify opportunities to increase efficiency, improve service levels, ensure regulatory compliance, and advance technology-enabled process improvements through enhanced operations and implementation of enterprise solutions.
• Develop strategies to realize improvement opportunities, ensure organizational prioritization and resource alignment, and support business objectives through scalable technology and workflow transformation initiatives.
• Manage multiple projects through the full project lifecycle, including requirements gathering, solution design, creation of project plans and schedules, obtaining and managing resources, managing budget, facilitating system configuration, user acceptance testing, implementation, deployment, and go-live activities.
• Utilize corporate and industry-standard project management tools and techniques to effectively manage projects, establish governance frameworks, and support controlled, low-risk implementation approaches.
• Maintain detailed project documentation as needed, including action items, issues lists, risk mitigation plans, success metrics, testing documentation, and implementation readiness materials.
• Provide leadership and effectively communicate project status to all stakeholders, including executive summaries, presentations, dashboards, and reports that support enterprise decision-making and investment prioritization.
• Negotiate with project stakeholders to identify and secure resources, resolve issues, mitigate risks, and ensure alignment across business, technology, operational, and vendor teams.
• Lead cross-functional meetings with various functional areas to meet overall stakeholder expectations and company objectives, including solution design sessions, governance reviews, testing activities, and implementation readiness discussions.
• Provide functional and technical knowledge regarding overall program requirements and operations while serving as a trusted advisor who translates complex technical concepts, risks, and recommendations for diverse stakeholder groups.
• Define and track project success metrics, implementation outcomes, and business value realization to ensure solutions improve effectiveness, reduce operational friction, and support long-term adoption and scalability.

Education/Experience:

• Bachelor’s degree in Business Administration, Healthcare Administration, related field, or equivalent experience. Master’s degree preferred.
• 5+ years project implementation, product or program management experience.
• Managed care or prescription benefit management experience preferred.

Preferred:

• Demonstrated ownership and initiative with a desire to drive significant, measurable results.
• Strong project management, analytical skills, and high attention to detail.
• Proven track record of successful project deliveries at the enterprise level.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act