Program Manager, Healthcare Services

***Remote and must live in the United States*** JOB DESCRIPTION Job Summary Provides subject matter expertise and leadership to support the alignment and implementation of enterprise healthcare services strategies across health plans. Serves as a liaison between enterprise and market teams, facilitating communication, identifying operational risks and opportunities, supporting change management efforts, and promoting consistency in program implementation. Ensures awareness of regulatory, contractual, and organizational priorities while contributing to the successful execution of enterprise initiatives that improve member outcomes and operational performance.

Essential Job Duties

Collaborates with enterprise and market stakeholders to support the planning, implementation, and sustainment of healthcare services initiatives, ensuring alignment with organizational goals and market needs. Serves as a key communication conduit between enterprise teams and health plans, facilitating two-way feedback, issue resolution, and information sharing. Supports governance and oversight activities by identifying implementation barriers, operational risks, and opportunities for process improvement, while partnering with stakeholders to develop and monitor action plans. Provides consultation and operational guidance to health plans regarding enterprise programs, strategic initiatives, regulatory requirements, and best practices. Facilitate cross-functional collaboration among clinical, operational, compliance, analytics, and other business partners to drive successful implementation of initiatives. Leads or supports organizational change management efforts, including stakeholder engagement, communication planning, and adoption strategies. Monitors initiative progress, evaluates outcomes, and communicates status, risks, dependencies, and recommendations to leadership and key stakeholders. Partners with enterprise teams and health plans to gather business requirements, document operational needs, and support implementation planning for new processes, tools, programs, and reporting capabilities. Develops and maintains project documentation, communication materials, implementation guides, executive summaries and other resources to support stakeholder engagement and operational execution. Supports market readiness and adoption of enterprise initiatives through training coordination, facilitation of workgroups, and ongoing operational support. Analyzes market feedback, performance trends, and emerging issues to inform enterprise decision-making and continuous improvement efforts.

At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience. Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. Strong analytical and problem-solving skills. Strong organizational and time-management skills. Ability to work in a cross-functional, professional environment. Experience working within applicable state, federal, and third-party regulations. Strong verbal and written communication skills. Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.

Certified Case Manager (CCM), Certified