Senior Program Manager - Medicare Network Performance and Operations - Remote
Job Title
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, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members.
Leads CMS/HPMS submission activities and ongoing monitoring, including:
- Health Service Delivery (HSD) tables
- Exception Requests
- Service Area Expansions (SAE)
- Triennial network adequacy reviews
- What if scenarios to network sculpting
Coordinates with Product and Markets teams to ensure accurate and timely updates related to:
- Notices of Intent to Apply (NOIAs)
- Notices of Intent to Deny (NOIDs)
- Service area withdrawals
Reviews regulatory documentation within Innovare and ensures alignment with CMS requirements, including:
- Network adequacy guidance
- Templates
- Supporting regulatory documentation
Manages leaders and teams responsible for planning and executing business programs. Assigns, directs, and monitors the work of program management staff. Serves as a subject matter expert for Program Managers and functional teams. Leads programs to meet critical business objectives and operational needs. Collaborates with customers and stakeholders to translate business needs and goals into functional requirements. Partners with operational leaders to identify and recommend process improvement opportunities.
Develops and maintains:
- Business requirements documents (BRDs)
- Test plans
- Requirements traceability matrices (RTMs)
- User training materials
- Related project documentation
Develops, defines, and executes:
- Program plans
- Project schedules
- Deliverables
Monitors and manages programs from initiation through delivery.
Required Education: Bachelor's Degree or equivalent combination of education and experience
Required Experience: 7-9 years
Required License, Certification, Association: PMP Certification (and/or comparable coursework)
Preferred Education: Graduate Degree or equivalent combination of education and experience
Preferred Experience: 10+ years
Preferred License, Certification, Association: Six Sigma Black Belt Certification, ITIL Certification desired
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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