Program Manager IV - Clinical Optimization

Medica; Hopkins (MN); On-site; USD 89,000 - 152,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401K contributions

Paid time off

Job summary

Medica is seeking a Program Manager IV within the Clinical Optimization team to lead strategic initiatives across clinical platforms such as GuidingCare and Wellframe. This role partners with business, IT, and vendors to translate strategy into executable plans and scalable operations.

The position requires guiding complex programs with strong communication, stakeholder management, and analytical capabilities, and it offers an onsite work arrangement with offices in Minnetonka, MN or Madison, WI.

Qualifications

• Bachelor's degree or equivalent experience in related field.
• 7+ years of work experience beyond degree.
• Strong ability to lead complex initiatives across multiple stakeholders.
• Excellent communication and stakeholder management skills across all organizational levels.
• Strong analytical, organizational, and problem-solving abilities.

Responsibilities

• Lead complex, cross-functional initiatives impacting clinical systems (e.g., platform migration, workflow redesign, automation efforts).
• Drive end-to-end delivery from strategy through execution, ensuring alignment to enterprise goals.
• Partner with implementation, business, and IT teams to define scope, timelines, and success measures.
• Act as primary point of coordination across stakeholders to ensure alignment and progress.
• Identify and drive opportunities for process optimization, automation, and capability enhancement.
• Translate business needs into system-level changes across GuidingCare and integrated platforms.
• Support evaluation and adoption of new vendor capabilities and product enhancements.
• Lead workflow redesign initiatives to improve efficiency, quality, and scalability.

Skills

Stakeholder management

Leadership

Communication skills

Analytical thinking

Project management

Education

Bachelor's degree or equivalent

Tools

GuidingCare

Wellframe

UM/CM workflows

Job description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This role works within Medica's Clinical Optimization team, leading strategic initiatives focused on clinical system transformation, automation, and optimization. The Program Manager IV is responsible for driving complex, cross-functional programs that impact clinical platforms such as GuidingCare and Wellframe, translating business strategy into executable plans across people, process, and technology.

This position serves as a key change agent, partnering with business, IT, and vendor stakeholders to deliver enterprise initiatives, improve workflows, and enable scalable operational capabilities. Performs other duties as assigned.

Key Accountabilities

• Strategic Initiative Leadership
  • Lead complex, cross-functional initiatives impacting clinical systems (e.g., platform migration, workflow redesign, automation efforts)
  • Drive end-to-end delivery from strategy through execution, ensuring alignment to enterprise goals
  • Partner with implementation, business, and IT teams to define scope, timelines, and success measures
  • Act as primary point of coordination across stakeholders to ensure alignment and progress
• Optimization & Transformation
  • Identify and drive opportunities for process optimization, automation, and capability enhancement
  • Translate business needs into system-level changes across GuidingCare and integrated platforms
  • Support evaluation and adoption of new vendor capabilities and product enhancements
  • Lead workflow redesign initiatives to improve efficiency, quality, and scalability
• Cross-Functional Collaboration & Governance
  • Collaborate with internal stakeholders, IT partners, and external vendors to deliver integrated solutions
  • Ensure alignment between strategic priorities, operational needs, and technical capabilities
  • Facilitate prioritization and intake of enhancement requests and track progress to delivery
  • Communicate impacts of changes to stakeholders and ensure organizational readiness
• Portfolio & Roadmap Management
  • Support development and execution of roadmap for clinical platform enhancements and initiatives
  • Monitor program progress, identify risks, and proactively resolve issues or elevate barriers
  • Ensure initiatives align with regulatory, compliance, and organizational requirements
  • Provide updates and insights to leadership on initiative status and outcomes

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 7+ years of work experience beyond degree
• Strong ability to lead complex initiatives across multiple stakeholders
• Excellent communication and stakeholder management skills across all organizational levels
• Strong analytical, organizational, and problem-solving abilities
• Ability to balance strategic thinking with execution-level detail
• Demonstrated ability to influence without direct authority and drive outcomes

Preferred Qualifications

• Experience working with clinical systems (e.g., GuidingCare, Wellframe, UM/CM workflows)
• Experience with vendor-managed platforms and integrations
• Background in healthcare operations, claims, or clinical services

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US

Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.