Program Manager- Quality Compliance - Remote CA

Molina Healthcare•Long Beach, CA

4d•Remote

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. 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 leadership on projects that support Quality compliance with regulatory and accreditation efforts. Act as the primary liaison between internal departments (e.g., CA Quality, MHI Quality, Healthcare Services, Government Contracts, Network, Compliance, etc.) to ensure policies, procedures, and workflows align with NCQA requirements. Evaluate and interpret accreditation guidelines at least annually, monitoring performance metrics (HEDIS, CAHPS) to ensure compliance with standards. Prepares and submits necessary documentation, reports, and evidence of compliance for regulatory compliance and NCQA accreditation. 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.

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.
Understanding of NCQA Accreditation standards, HEDIS, CAHPS and state regulatory requirements (DHCS, DMHC).
Strong project management skills, including ability to manage timelines, facilitate meetings and communicate changes in NCQA accreditation standards and state regulations.
Proficient in Microsoft Office.

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 leadership on projects that support Quality compliance with regulatory and accreditation efforts.
Acting as the primary liaison between internal departments to ensure policies, procedures, and workflows align with NCQA requirements.
Evaluating and interpreting accreditation guidelines at least annually, monitoring performance metrics (HEDIS, CAHPS) to ensure compliance with standards.
Preparing and submitting necessary documentation, reports, and evidence of compliance for regulatory compliance and NCQA accreditation.
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.