Program Manager (Marketplace Network Strategy & Payment Optimization) REMOTE

Molina Healthcare; United States; Remote; USD 110,000 - 170,000; Full time

Job summary

Molina Healthcare is seeking a Program Manager to lead governance and delivery of Marketplace Network Strategy initiatives. You will establish structure, accountability, and reporting, partnering with Network Strategy leadership to optimize provider reimbursement and enterprise network execution.

Responsibilities include creating governance frameworks, dashboards, KPIs, and cross-functional collaboration with legal, IT, and other teams to ensure value realization and adherence to policy. EOE.

Qualifications

• 5+ years of progressive program/project management in a complex, matrixed organization.
• Experience leading medium-scale or multi-functional healthcare programs.
• Operational process improvement and change management experience.
• Data analysis skills/experience.
• Strong organizational and time-management skills.
• Ability to manage multiple projects with competing priorities.
• Experience budgeting and resource planning for initiatives.
• Ability to collaborate across a highly matrixed organization.
• Advanced MS Office suite proficiency (Excel, PowerPoint, Project, Visio).

Responsibilities

• Oversees design, implementation, delivery, and ongoing operations of program(s) and services.
• Supports end-to-end program delivery with goals, scope, and success measures.
• Develops and maintains governance frameworks for compliant program management.
• Oversees budgets and resource prioritization for programs.
• Partners with executive sponsors to meet objectives and realize value.
• Drives performance measurement with dashboards and KPIs.
• Ensures governance standards and playbooks are up-to-date.
• Collaborates with legal, compliance, IT, and cross-functional teams.
• Tracks performance metrics and ensures value realization.
• Coordinates governance meetings and decision-making processes.
• Oversees portfolio management and initiative changes.
• Disseminates guardrails and best practices across teams.
• Reviews program collateral for accuracy and relevance.
• Champions change management and stakeholder engagement.
• Maintains program documentation and lessons learned.
• Identifies opportunities for enhancements and BRDs.

Skills

Program management

Cross-functional collaboration

Data analysis

Communication skills

Budgeting

Change management

Leadership

Education

PMP Certification

Six Sigma Green Belt

Tools

Microsoft Excel

PowerPoint

Microsoft Project

Visio

Job description

JOB DESCRIPTION

Job Summary

This role serves as the program management and governance lead for key Marketplace Network Strategy initiatives. The Program Manager is responsible for creating structure, accountability, reporting, and cross-functional coordination for programs that support affordability, provider reimbursement optimization, and enterprise network strategy execution. The role acts as a business partner to Network Strategy leadership and helps ensure resources are focused on the highest-value opportunities.

Essential Job Duties

• Oversees the design, implementation, delivery, and ongoing operations of respective business program(s) and services.
• Supports end-to-end program delivery by establishing goals, scope, and success measures aligned with organizational priorities.
• Develops and maintains governance frameworks to ensure consistent, compliant, and effective program management practices.
• May oversee financial stewardship of program budgets - ensuring proper prioritization and alignment of resources to achieve desired outcomes.
• Partners with executive sponsors and functional leaders to ensure program objectives are met and value is realized across business units.
• Drives performance measurement and reporting, including dashboards, key performance indicators (KPIs), and post-implementation reviews to track outcomes and identify opportunities for continuous improvement.
• Ensures well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program(s).
• Collaborates with legal, compliance, information technology (IT), and other cross-functional teams 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.
• Oversees portfolio management and/or initiative-specific programmatic changes and project management.
• Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices, etc.
• Routinely reviews program collateral to ensure current and accurate reflection of business needs.
• Promotes consistency in planning, communication, and execution across initiatives.
• Champions organizational change management by ensuring effective stakeholder engagement, communication, and adoption of new processes or technologies.
• Maintains and evolves program documentation, playbooks, and best practices to reflect current business needs and lessons learned.
• Identifies opportunities/gaps and provides recommendations on program enhancements to applicable leaders.
• Creates business requirements documents (BRDs), test plans, requirements traceability matrices, user training materials and other related documentation.
• Generates and distributes required business/programmatic reporting.
• Facilitates special functional/departmental projects.
• May provide specialized training and support to new and existing staff as needed.

Required Qualifications

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

Preferred Qualifications

• Project Management Professional (PMP), Six Sigma Green Belt and/or Black Belt certification.
• Health care/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 within a healthcare or managed care environment.
• Experience with Marketplace, Commercial, Medicare, or Medicaid health plan operations and provider network management preferred.

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V