Program Manager, Healthcare Services

Molina Healthcare is a leading provider in the healthcare sector, and they are seeking a Program Manager to provide subject matter expertise and leadership in their healthcare services function. This role involves planning and executing healthcare services projects, ensuring compliance with standards and regulations, and improving processes to enhance member care.

Responsibilities:

• 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
• Owns the design and execution for system implementation, updates, and enhancements for a highly integrated, cross-functional application

Requirements:

• 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
• 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
• Experience with LTSS
• Experience with HEDIS/Gaps in Care