Program Manager (Claims - MST hours)

Molina Healthcare; Las Cruces (NM); On-site; USD 66,000 - 130,000; Full time

Job summary

Molina Healthcare in Las Cruces, NM is seeking a Program Manager to oversee the claims and claims configuration portfolio, delivering policy, workflow and process documentation that aligns with governance standards. You will manage budgets, coordinate governance meetings, collaborate with Legal, Compliance and Information Security, and track metrics to ensure value realization from deployed solutions.

The ideal candidate has 4+ years in program or project management, strong communication, and

Qualifications

• At least 4 years of program and/or project management experience.
• Operational process improvement experience.
• Managed care experience, preferably in a shared service, CoE or matrixed environment.
• Strong presentation and communication skills.
• Experience with Microsoft Project and Visio.

Responsibilities

• Provide policy, workflow and process documentation for claims & claims configuration.
• Manage program budget and support project prioritization.
• Collaborate with Legal, Compliance and Information Security to uphold governance standards.
• Track performance metrics and ensure value realization from deployed solutions.
• Coordinate governance meetings and decision-making processes.
• Support portfolio management and change initiatives as directed.
• Collaborate with stakeholders to disseminate and adopt program guardrails and best practices.
• Routinely review program collateral to reflect business needs.
• Identify opportunities and provide recommendations for enhancements.
• Create business requirements documents, test plans, requirements traceability, training materials.
• Generate and distribute standard reports on schedule.

Skills

Program management

Project management

Stakeholder communication

Process improvement

Presentation skills

Tools

Microsoft Project

Visio

Job description

JOB DESCRIPTION

Job Summary

Provides support to Molina functional areas (Claims, and claims configuration) 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.

Job Duties

• Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective claims & claims configuration 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.

JOB QUALIFICATIONS

REQUIRED QUALIFICATIONS :

• 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.

PREFERRED QUALIFICATIONS :

• Clams & claims configuration experience.

• QNXT

• Provider Relations

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $66,456 - $129,590 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.