Program Manager (Appeals & Grievances Oversight of Regulatory Inquiries and Executive Complaints for CT)

Molina Healthcare•Long Beach, CA

12d

About The Position

Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable. This position supports Appeals and Grievances for the state of Connecticut. The role involves working with Connecticut regulators and handling inquiries, cases for research and response to Regulators including DOI. This positions addresses executive complaints, regulatory inquiries and involves working on tight turnaround time deadlines. This is a visible role as the candidate should feel comfortable presenting to the executive team in meetings. This role supports multiple work groups and would attend multiple meetings representing Appeals and Grievances scheduled by health plan executives. This role involves reporting and presenting data.

Requirements

At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience.
Operational Process Improvement experience.
Managed Care experience, preferably in a shared service, CoE or matrixed environment.
Experience with Microsoft Project and Visio.
Strong presentation and communication skills.

Responsibilities

Ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program.
Managing program budget, as applicable, supporting project prioritization.
Collaborating with Legal, Compliance, and Information Security to ensure governance standards are upheld.
Tracking performance metrics and ensuring value realization from deployed solutions.
Coordinating recurring meetings to support governance framework and decision-making processes, as needed.
Supporting portfolio management and/or initiative-specific change and project management at the direction of program leadership.
Collaborating with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral.
Routinely reviewing program collateral to ensure current and accurate reflection of business needs.
Identifying opportunities/gaps and providing recommendations on program enhancements to respective leadership team.
Creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
Generating and distributing standard reports on schedule.