Program Manager -Payment Integrity/Prepayment Solutions

Molina Healthcare is hiring for a Program Manager – Payment Integrity/Prepayment Solutions Implementation.
This role is remote and can be worked from states we are focused on hiring in.

Highly qualified candidates will have the following experience-

• Knowledge of claims / claims processing.
• Experience working within Payment Integrity and/or Prepayment solutions.
• Project Management, and/or Technical Project Management.
• Above average to expert level in Agile, Jira, PowerPoint, Excel
• Understanding of who claims vendors are and what they do. Experience engaging vendors and ensuring the technologies are being implemented.
• Coding experience a plus!
• Familiar with QNXT is a plus.

Job Summary
Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management.

Job Duties

• Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.
• Plans and directs schedules as well as project budgets.
• Monitors the project from inception through delivery.
• May engage and oversee the work of external vendors.
• Focuses on process improvement, organizational change management, program management and other processes relative to the business.
• Leads and manages team in planning and executing business programs.
• Serves as the subject matter expert in the functional area and leads programs to meet critical needs.
• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.
• Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
• Generate and distribute standard reports on schedule.
• Possible travel up to twice per year.

JOB QUALIFICATIONS

REQUIRED EDUCATION: Combination of education and experience or Bachelor's Degree.
PREFERRED EDUCATION: Combination of education and experience or Graduate Degree.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3-5 years of Program and/or Project management experience.
• Operational Process Improvement experience.
• Healthcare experience.
• Experience with Microsoft Project and Visio.
• Excellent presentation and communication skills.
• Experience partnering with different levels of leadership across the organization.

PREFERRED EXPERIENCE:

• 5-7 years of Program and/or Project management experience.
• Managed Care experience.
• Experience working in a cross functional highly matrixed organization.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Same Posting Description for Internal and External Candidates

Key Words:

Project Management, Business Owner, Healthcare, Data, Provider, Provider Liaison, Claims, Provider Claims, Stakeholder Engagement, Regulatory Compliance, Risk Management, Process Improvement, Data Analysis, Quality Assurance, Change Management, Agile Methodology, Strategic Planning, Resource Allocation, Performance Metrics, Vendor Management, Workflow Optimization, Healthcare Policies, Regulations, Clinical Operations, Leadership, Time Management, Communication Skills, Process Mapping, Training and Development, Healthcare Analytics, Regulatory Affairs, Medicaid Claims Expertise, Product Owner, Product knowledge, Claims Configuration & Payment Leadership, Process Management & Optimization