Program Manager (Marketplace Network Strategy & Payment Optimization) REMOTE

Molina Healthcare•Long Beach, CA

3d•Remote

About The Position

This role serves as the program management and governance lead for key Marketplace Network Strategy initiatives. The Program Manager creates structure, accountability, reporting, and cross-functional coordination for programs supporting affordability, provider reimbursement optimization, and enterprise network strategy execution. The role partners with Network Strategy leadership and helps ensure resources are focused on the highest-value opportunities. The Program Manager oversees the design, implementation, delivery, and ongoing operations of business programs and services. The role establishes program goals, scope, and success measures; develops governance frameworks; supports budget and resource stewardship; partners with executive sponsors and functional leaders; and measures performance and value realization. It also maintains program policies, workflows, controls, playbooks, and other documentation; coordinates governance and decision-making meetings; manages portfolios and programmatic changes; and supports stakeholder engagement, communication, adoption, and continuous improvement. The role may also facilitate special projects and provide training and support to staff.

Requirements

At least 5 years of progressive program and/or project management experience with increasing responsibility in a complex, matrixed organization, or an equivalent combination of relevant education and experience.
Experience leading medium-scale or multifunctional programs within healthcare, managed care, or a similar regulated environment.
Operational process improvement and change management experience.
Project management experience and skills.
Data analysis skills or experience.
Strong organizational and time-management skills.
Ability to manage multiple projects simultaneously with competing priorities.
Experience managing budgets and resource plans for business or strategic initiatives.
Ability to collaborate across a highly matrixed organization.
Strong verbal, written, and presentation communication skills, with the ability to influence at all organizational levels.
Advanced proficiency with Microsoft Office, including Excel, PowerPoint, Project, and Visio, and applicable software programs.

Nice To Haves

Project Management Professional (PMP), Six Sigma Green Belt, and/or Black Belt certification.
Healthcare or managed care experience.
Experience leading complex, cross-functional healthcare initiatives involving Provider Contracting, Claims, Finance, Operations, and Network Management teams.
Knowledge of provider reimbursement methodologies, fee schedule development, healthcare payment models, and medical cost optimization strategies.
Experience supporting health plan network strategy, provider negotiations, affordability initiatives, or payment integrity programs.
Demonstrated ability to develop governance frameworks, executive reporting, risk mitigation plans, and stakeholder communication strategies for enterprise programs.
Experience managing external vendor relationships and consulting partnerships in a healthcare or managed care environment.
Experience with Marketplace, Commercial, Medicare, or Medicaid health plan operations and provider network management.

Responsibilities

Oversee the design, implementation, delivery, and ongoing operations of assigned business programs and services.
Establish program goals, scope, and success measures aligned with organizational priorities.
Develop and maintain governance frameworks for consistent, compliant, and effective program management.
Support financial stewardship of program budgets and prioritize resources to achieve desired outcomes.
Partner with executive sponsors and functional leaders to meet program objectives and realize value across business units.
Drive performance measurement and reporting, including dashboards, KPIs, and post-implementation reviews.
Document and maintain policies, workflows, program controls, internal and third-party practices, playbooks, and best practices.
Collaborate with legal, compliance, IT, and other cross-functional teams to uphold governance standards.
Track performance metrics and value realization from deployed solutions.
Coordinate recurring meetings to support governance frameworks and decision-making.
Oversee portfolio management and initiative-specific programmatic changes and project management.
Support dissemination and adoption of program guardrails, processes, and best practices among stakeholders.
Review program collateral to ensure it accurately reflects current business needs.
Promote consistency in planning, communication, and execution across initiatives.
Support organizational change management through stakeholder engagement, communication, and adoption of new processes or technologies.
Maintain and evolve program documentation, playbooks, and best practices based on current needs and lessons learned.
Identify program opportunities and gaps and recommend enhancements to leaders.
Create business requirements documents, test plans, requirements traceability matrices, user training materials, and related documentation.
Generate and distribute required business and program reports.
Facilitate special functional or departmental projects.
Provide specialized training and support to new and existing staff as needed.