Program Manager (Appeals & Grievances Oversight of Regulatory Inquiries and Executive Complaints for CT)

Job Description

Job Summary

Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable.

This position supports Appeals and Grievances for the state of Connecticut. The role involves working with Connecticut regulators and handling inquiries, cases for research and response to Regulators including DOI. This positions addresses executive complaints, regulatory inquiries and involves working on tight turnaround time deadlines. This is a visible role as the candidate should feel comfortable presenting to the executive team in meetings. This role supports multiple work groups and would attend multiple meetings representing Appeals and Grievances scheduled by health plan executives. This role involves reporting and presenting data.

Job Duties

• Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program.
• Manages program budget, as applicable, supporting project prioritization.
• Collaborates with Legal, Compliance, and Information Security 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, as needed.
• At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management.
• Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral.
• Routinely reviews program collateral to ensure current and accurate reflection of business needs.
• Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team.
• Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
• Generates and distributes standard reports on schedule.

Job Qualifications

REQUIRED QUALIFICATIONS:

• At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience.
• Operational Process Improvement experience.
• Managed Care experience, preferably in a shared service, CoE or matrixed environment.
• Experience with Microsoft Project and Visio.
• Strong presentation and communication skills.

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.

Pay Range: $59,810.6 - $129,589.63 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.