Program Manager, Provider Data Config NM Medicaid Remote

Molina Healthcare•Long Beach, CA

6h•Remote

About The Position

Molina of New Mexico is hiring for a Program Manager, Provider Data Config. This position is remote, however qualified candidates will have in-depth knowledge of New Mexico Medicaid operations. This role is critical to maintaining provider data accuracy, overseeing audits, and supporting configuration activities that directly impact claims adjudication and provider payment. This role supports accurate provider data and claims configuration to ensure providers are paid correctly and members experience seamless access to care. This position sits within Operations and supports the Medicaid, Marketplace and Medicare line of businesses. Key responsibilities include Health Plan Provider Data Management, provider data audits, and system configuration to ensure accurate provider information and claims processing. The role 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.

Requirements

Strong understanding of New Mexico Medicaid operations
Experience with QNXT
Prior Provider Data Management (PDM) experience
Strong organizational skills
Attention to detail
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

Nice To Haves

Audit and configuration experience preferred

Responsibilities

Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program.
Manages program budget, as applicable, supporting project prioritization.
Collaborates with Legal, Compliance, and Information Security to ensure governance standards are upheld.
Tracks performance metrics and ensures value realization from deployed solutions.
Coordinates recurring meetings to support governance framework and decision-making processes, as needed.
At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management.
Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral.
Routinely reviews program collateral to ensure current and accurate reflection of business needs.
Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team.
Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
Generates and distributes standard reports on schedule.