Program Manager (Provider Engagement, Risk Adjustment, & Quality Improvement)

• JOB DESCRIPTION

JOB SUMMARY

Provides subject matter expertise and support for program management activities. Supports programmatic business needs across department and/or cross-functional areas, including program design, implementation, administration, governance, workflow analysis, process improvements, vendor management, policy and playbook development and maintenance, best practices, resource allocations, and special projects.

This role requires strong program/project management skills with the ability to independently manage multiple workstreams, timelines, deliverables, and stakeholders while driving initiatives through completion. The Program Manager is expected to be a proactive, self-directed problem solver with strong technical and data analysis capabilities, including the ability to analyze reports, dashboards, and large data sets and translate findings into actionable business insights.

Healthcare experience supporting provider engagement, risk adjustment, quality improvement, or similar healthcare programs is preferred.

Essential Job Duties

• Oversee the design, implementation, delivery, and ongoing operations of respective business program(s) and services.
• Supports end-of-the-end program delivery by establishing goals, scope, timelines, deliverables, dependencies, and success measures aligned with organizational priorities.
• Manages multiple program and project workstreams simultaneously, coordinating timelines, deliverables, stakeholders, risks, and dependencies while driving initiatives through completion.
• 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.
• Analyzes reports, dashboards, operational metrics, and large data sets to identify trends, performance gaps, risks, and opportunities and translates findings into actionable business insights and recommendations.
• Ensures well-documented policies, workflows, program controls, internal and third-party practices, playbooks, SOPs, and best practices for respective program(s).
• Collaborates with legal, compliance, information technology (IT), analytics, operations, provider engagement, and other cross-functional teams to ensure governance standards and program requirements are upheld.
• Tracks performance metrics and ensures value realization from deployed solutions.
• Coordinates recurring meetings to support governance frameworks, decision-making processes, accountability, and timely completion of action items.
• 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, and program requirements.
• 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, SOPs, and best practices to reflect current business needs and lessons learned.
• Proactively identifies program issues, workflow gaps, and performance barriers; performs root-cause analysis; develops recommended solutions and next steps; and drives issues toward resolution rather than relying solely on escalation.
• Demonstrates independent ownership of assigned initiatives by proactively identifying priorities and next steps, learning new processes quickly, and driving deliverables with minimal direction.
• 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, process documentation, and other related documentation.
• Generates and distributes required business/programmatic reporting and validates reporting outputs for accuracy and completeness.
• 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.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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