Program Manager – Clinical Data Acquisition Strategy & Performance – Remote

Molina Healthcare•Long Beach, AZ

20h•Remote

About The Position

The Program Manager, Clinical Data Acquisition provides support to Molina’s risk Adjustment Clinical Data Acquisition teams 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. Program Manager is responsible for leading and supporting internal business projects and cross functional teams of subject matter experts to ensure the accurate and timely collection of medical records and clinical data that drive Risk Adjustment and Quality performance and compliance. This role partners closely with key stakeholders and business leaders to identify operational improvement opportunities and implement innovative solutions that reduce expense, streamline workflows, and enhance organizational outcomes through expedited delivery and emerging technologies, including AI. The Program Manager also coordinates data research activities and leads initiatives to improve the accuracy and completeness of data related to medical record collection, abstraction, and over read processes.

Requirements

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.

Responsibilities

Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks, and best practices for respective programs.
Serves as industry Subject Matter Expert in the functional area and leads programs to meet critical needs
Ensures accurate, compliant, and timely delivery of data for Risk Adjustment initiatives across Medicare, Medicaid, and Marketplace lines of business.
Partners with operational and technical teams to enhance data workflows, improve retrieval efficiency, and streamline provider facing processes.
Supports the development and rollout of provider education strategies and materials related to documentation, data submission, and risk adjustment accuracy.
Aides in developing provider facing and internal communication materials, including marketing collateral, education content, and informational guides.
Identifies opportunities for workflow enhancement, automation, and process redesign within clinical data acquisition.
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.