Medicaid Project Manager

Medicaid Project Manager Location: Hawaii (Hybrid if on island, remote capability for mainland-based candidates) Overview TEKsystems is supporting a leading healthcare payer seeking a Medicaid Project Manager to lead end-to-end operational and process transformation initiatives within its Medicaid line of business. This role is responsible for optimizing claims and operational workflows, improving vendor performance, and enhancing data visibility through effective reporting and dashboards. The ideal candidate will bring strong Medicaid and claims expertise, a process improvement mindset, and the ability to translate operational data into actionable insights that drive performance and continuous improvement across the Medicaid lifecycle. Key Responsibilities Program & Process Transformation Lead initiatives to restructure and optimize end-to-end Medicaid operational workflows, from intake through adjudication and downstream processes Identify workflow inconsistencies, operational gaps, and inefficiencies, and design scalable, sustainable solutions Drive continuous improvement efforts to reduce manual work, improve processing timelines, and enhance quality outcomes Claims & EDI (837) Oversight Support and oversee 837 transaction processing and the full claims lifecycle Analyze breakdowns across claims workflows to improve accuracy and reduce rework Partner with Medicaid encounters, IT, data, and operational teams to improve system integration, mapping, and data integrity Data, Reporting & Dashboard Development Define KPIs and reporting requirements to measure operational performance, workflow efficiency, and error rates Partner with analytics and IT teams to design and enhance dashboards that provide actionable operational insights Evaluate existing reporting structures and improve visibility, accuracy, and timeliness Translate business needs into reporting and data solutions that support proactive decision-making System Monitoring & Operational Visibility Develop a strong understanding of systems, tools, and data sources supporting Medicaid operations Identify gaps in system monitoring and establish strategies to improve end-to-end visibility Collaborate with IT and business teams to enhance system-level tracking, alerts, and reporting capabilities Enable early identification of issues and operational bottlenecks through improved transparency Error Identification & Issue Management Establish mechanisms to identify, track, and manage errors across end-to-end processes Implement structured root cause analysis and long-term remediation approaches Monitor trends to prevent recurring issues and improve operational outcomes Vendor Management Support oversight of vendors supporting Medicaid operations Monitor vendor performance through data-driven metrics and SLA tracking Drive accountability and continuous improvement with vendor partners Stakeholder Collaboration Collaborate cross-functionally with operations, IT, compliance, data, and vendor teams Facilitate working sessions to identify process, system, and reporting improvements Communicate insights, risks, and performance trends to leadership using clear, data-driven storytelling Qualifications Required Experience in healthcare payer operations, with Medicaid experience strongly preferred Strong understanding of claims processing and operational workflows, including 837 transactions Experience leading cross‑functional programs or transformation initiatives Demonstrated ability to redesign processes, identify gaps, and drive operational improvements Experience working with reporting, dashboards, or data‑driven performance management Ability to understand system architecture and data flow across multiple platforms Preferred Knowledge of Medicaid regulations and compliance requirements Experience working in complex or legacy system environments Exposure to vendor management and SLA‑based performance tracking Why This Role Opportunity to modernize and improve long‑standing Medicaid operational processes High visibility role with direct impact on efficiency, quality, and outcomes Collaborative environment working across operations, IT, data, and leadership Hybrid work environment with flexibility Job Type & Location This is a Contract position based out of Honolulu, HI. Pay and Benefits The pay range for this position is $40.00 - $58.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan – Pre‑tax and Roth post‑tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long‑term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Honolulu, HI. Application Deadline This position is anticipated to close on Jul 28, 2026. Equal Opportunity Employment The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. San Francisco Fair Chance Ordinance Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI) We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools. #J-18808-Ljbffr