Molina Healthcare is hiring for a Project Manager, Change Management Liaison, Medicaid Claims.This role acts as the Business Owner and is responsible for ensuring the health plan is ready for any change focusing on Provider and Provider Claims/Claims payment.Highly qualified candidates should be very strong in Provider Claims and Provider Relations. Candidates should also have a high proficiency with Excel and SQL.This role will plan and direct schedules as well as project budgets. Monitors projects from inception through business readiness and delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. This positions’ primary focus is project/process/program management along with continuous improvements related to improving the provider experience.KNOWLEDGE/SKILLS/ABILITIES
Manages all aspects of assigned projects throughout the project lifecycle including project scope, schedule, resources, quality, costs, and change.
Develops and maintains detailed project plan to include milestones, tasks, and target/actual dates of completion.
Revises project plans as appropriate to meet changing needs and requirements.
Prepares and submits project status reports to management.
Schedules and conducts project meetings to include logistics, agendas, and meeting minutes.
Ensure successful hand off from project status to business as usual status.
JOB QUALIFICATIONSRequired Education : Associate degree or equivalent combination of education and experience.Preferred Education : Bachelor's Degree or equivalent combination of education and experienceRequired Experience : 3-5 years’ experience.Preferred Experience : 5-7 years’ experience in any of the or combination of the following-
Medicaid Claims Expertise – Strong experience in Medicaid claims configuration, adjudication, and payment processes.
Claims Troubleshooting & Issue Resolution – Deep understanding of the end-to-end claims lifecycle, including the interactions between provider contracts, provider data, contract configuration IDs, clearinghouse processes, EDI systems (such as Edifecs), claims adjudication, claims payment, and encounter submissions.
Product & Contract Configuration Knowledge – Experience managing dependencies related to product and contract configuration within a Medicaid managed care environment.
Independent Problem-Solving & Process Improvement – Proven ability to troubleshoot issues independently with a strong bias for identifying root causes and implementing process improvements.
Claims Configuration & Payment Leadership – 5-7 years of hands-on experience in claims configuration, ensuring accurate processing and compliance with Medicaid regulations.
Medicaid Managed Care Project Management – Experience leading or supporting operational projects within a Medicaid managed care setting.
Process Management & Optimization – Strong ability to assess, refine, and document business processes to drive efficiency and accuracy .
Microsoft SharePoint & Teams Proficiency – Experience leveraging Microsoft SharePoint and Teams for collaboration, document management, and workflow automation.
Preferred License, Certification, Association : PMP or Six Sigma Green Belt certificationTo 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.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 & OptimizationPay Range: $77,969 - $135,480 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
