Program Manager, Healthcare Services (Enhanced Care Mgmt - Pst Hours)

Molina Healthcare; Los Angeles (CA); On-site; USD 84,000 - 164,000; Full time

Benefits offered by this job

Competitive benefits package

EOE M/F/D/V

Job summary

Molina Healthcare in Los Angeles, CA, seeks a senior healthcare services leader to oversee program design, execution, and evaluation while ensuring compliance with regulations and contracts. You will guide cross-functional teams, manage vendor relationships, and drive quality and cost-efficient member care.

The role emphasizes collaboration, analytical thinking, and strong communication within a regulatory-driven environment to deliver impactful healthcare services programs.

Qualifications

• Minimum 5 years health care experience including clinical operations.
• At least 3 years in utilization management, care management, transitions, or related areas.
• Active licensure required if mandated by state contract or regulations.
• Excellent written and verbal communication and documentation skills.

Responsibilities

• Lead and plan healthcare services projects with cross-functional teams.
• Ensure program goals and quality protocols are followed and documented.
• Oversee external vendors as needed.
• Drive process improvement and change management initiatives.
• Lead healthcare services programs to meet critical needs.
• Translate customer needs into functional requirements and BRDs.

Skills

Analytical skills

Time management

Communication skills

Cross-functional collaboration

Education

RN licensure

LPN/LVN licensure

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

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.

Essential Job Duties

• 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 relative 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.

Required Qualifications

• At least 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.
• Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Strong analytical and problem-solving skills.
• 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 suite/applicable software program proficiency, and ability to navigate online portals and databases.

Preferred Qualifications

• Knowledge of CalAIM(ECM or CS)
• Strong analytical skills
• Project managementexperience
• Strong attention to detail
• Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
• Leadership experience.
• Medicaid/Medicare population experience.

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

Pay Range: $84,067 - $163,931 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.