Program Manager, Provider Data Config NM Medicaid Remote

Molina of New Mexico is hiring for a Program Manager, Provider Data Config. This position is remote, however qualified candidates will have in-depth knowledge of New Mexico Medicaid operations. This role is critical to maintaining provider data accuracy, overseeing audits, and supporting configuration activities that directly impact claims adjudication and provider payment.

Highly qualified candidates will have the following experience-

• Strong understanding of New Mexico Medicaid operations
• Experience with QNXT
• Prior Provider Data Management (PDM) experience
• Audit and configuration experience preferred
• PDM and QNXT experience
• Strong organizational skills
• Attention to detail

Job Summary
This role supports accurate provider data and claims configuration to ensure providers are paid correctly and members experience seamless access to care

This position sits within Operations and supports the Medicaid, Marketplace and Medicare line of businesses. Key responsibilities include Health Plan Provider Data Management, provider data audits, and system configuration to ensure accurate provider information and claims processing

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. 

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.

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.

Key Words-

Turquoise Care, MCO, Managed Care, QNXT, PDM, Provider Data Management, Provider, Audits, Auditing, Performance, Operations, Config, Configuration, Provider Data, Centennial Care, ISD, MAD, 1115 Waiver, NPI, EVV, State Plan Amendment SPA, Value Added Services, VAS, Home and Community Based Services, HCBS, HCA, NM, New Mexico, ACA, CMS, Centers for Medicare & Medicaid Services

Pay Range: $66,456 - $129,590 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.