Project Manager – Managed Care

We are seeking a highly motivated and experienced Project Manager to lead and coordinate strategic initiatives related to New Jersey’s evolving Medicaid managed care landscape. This role involves managing the business aspects of state Medicaid implementations, ensuring that Integrity House effectively secures new contracts while meeting state requirements. The Project Manager will identify new market opportunities, developing strategic partnerships with payors, and overseeing the planning, execution, and completion of projects designed to expand our market presence and enhance service delivery.

The ideal candidate will bridge the gap between business development objectives, clinical requirements, and operational strategies.

Operational Expertise: manage the transition of billing processes from current fee for service model to MCO billing requirement, ensuring accurate and timely claim submission. Ensure all providers are properly enrolled with state Medicaid provider. Monitor and ensure all MCO contracts and associated billing rates meet or exceed previously identified FFS floor rates. Resolve claims processing issues, analyze reimbursement trends, and optimize revenue cycle performance.

Compliance: ensure all project activities adhere to healthcare industry and standards, including HIPAA, CMS, and Department of Health guidelines. Oversee policy and workflow updates and ensures that system changes correctly support various functions like claims processing, benefits administration, utilization management, and care coordination.

Market Analysis & Strategy: conduct detailed research on the NJ Medicaid market and regulatory landscape to identify growth opportunities and assess impacts to the operating model. Analyze competitor strategies and State policy to discern new business opportunities and partnerships. Plan, organize, monitor, and oversee complex projects related to new Medicaid managed care.

Business Development & Relationship Management: coordinate operational teams to translate contract requirements, market intelligence, and industry best practices into viable target operating models. Build and maintain strong relationships with potential stakeholders, partners, including NJ state agencies and regulators.

Stakeholder Management: act as key liaison, driving collaboration between internal cross-functional teams (clinical, IT, operations, finance, etc.), external partners, state officials, and vendors to ensure clarity regarding information and requirements.

• Bachelor’s degree in a related field, i.e. public health or healthcare administration, required.
• Experience in business development or strategy consulting within the managed care sector.
• Two (2) years’ experience of systems related to claims, benefits, and utilization management.
• Strong communication, analytical, and problem-solving skills.
• Ability to work independently and collaboratively to manage deadlines and adapt to changing priorities.

Work Schedule: Monday – Friday 9:00am-5:00pm, with the ability to work outside of standard working hours.

We believe that work is more than a place you go every day. It is about being inspired and motivated to achieve extraordinary things. We believe our company’s success comes from providing a workplace that offers variety, presence, and development. We offer a multitude of staff benefits to ensure the wellbeing of our teams.

• Low Cost and Generous Medical and Prescription Coverage (ask us for our benefits summary, we are proud of it!)
• Employer Paid Dental
• Employer Paid Vision
• Employer Paid Life and AD&D
• Employer Paid Long Term Disability
• Employer Paid Health Reimbursement Account
• Generous Vacation, Sick, Personal and Holiday Time
• 403(b) Plan with a Dollar for Dollar Match up to 3% of Compensation
• Employee Assistance Plan
• Flexible Spending Account
• Commuter Benefit Plan
• Tuition Reimbursement – up to $4,000 annual
• Recognition Rewards
• Professional Development Opportunities

Integrity House is New Jersey’s oldest provider of comprehensive substance use and mental health services. We’ve been a trusted source in our field since our founding in 1968, and our goal has remained constant: to help individuals and families experiencing addiction and mental health conditions measurably improve their health and overall quality of life.