Program Manager, Healthcare Services

Molina Healthcare•Long Beach, CA

About The Position

Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.

Requirements

5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
3-5 years of Managed Care experience
Strong analytical and problem-solving skills.
Provider relationship and oversight
Strong organizational and time-management skills.
Ability to work in a cross-functional, professional environment.
Experience working within applicable state, federal, and third-party regulations.
Strong verbal and written communication skills.
Microsoft Office suites applicable software program proficiency, and ability to navigate online portals and databases.
CalAIM experience

Nice To Haves

Leadership experience.
Medicaid population experience.
PMP
Six Sigma

Responsibilities

Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
May engage and oversee the work of external vendors.
Focuses on process improvement, organizational change management, program management and other processes related to business needs.
Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
Conducts quality audits to assess healthcare services staff educational needs and service quality and implements quality initiatives within the department as appropriate.
Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.