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Medica · 4 hours ago

Clinical Program Manager ePA

Madison, WI

Full-time

Hybrid

Senior Level, Lead/Staff

$98K/yr - $148K/yr

8+ years exp

Medica is a nonprofit health plan serving communities in multiple states. The Clinical Program Manager will oversee initiatives within the Clinical Services Optimization division, focusing on the electronic prior authorization (ePA) business delivery, ensuring operational efficiency, and leading cross-functional teams to achieve program objectives.

Health CareMedical

No H1B

Responsibilities

Lead Delivery and Optimization of ePA Workflow

Drive process efficiency and oversee the management of error handling within the electronic prior authorization (ePA) workflow

Lead business validation activities and user acceptance testing (UAT) to ensure that system solutions meet organizational needs and requirements

Assess and ensure that all systems and procedures are operating as designed, maintaining high standards for operational reliability and effectiveness

Evaluate requests for changes to the system, determining feasibility and implications for business operations

Develop actionable recommendations to address business system and reporting issues, ensuring continuous improvement and alignment with program objectives

Implement automation and standardized practices to reduce manual processes, eliminate duplication, and enhance overall operational efficiency

Research system functionality and provide subject matter expertise to business and project teams, supporting informed decision-making and effective system utilization

Support process improvement initiatives by collaborating with stakeholders to identify opportunities for enhancement and innovation

Guide recommendations and facilitate decision-making through active stakeholder engagement, ensuring that program goals and stakeholder interests are aligned

Interpret customer needs and translate them into clear application and operational requirements, serving as a bridge between end users and technical teams

Work cross functional with business partner to achieve program delivery

Create strong partner relationship to be successful

Drive Clinical and Health Service business readiness by leading for success strategies

Qualification

EPA Workflow ManagementBusiness Requirements GatheringUser Acceptance TestingProcess ImprovementMicrosoft Office ProficiencyCross-Functional CollaborationQuality FocusLeadershipCommunication Skills

Required

Bachelor's degree or equivalent experience in related field

8 years of related work experience beyond degree

Implementation and new capabilities delivery experience

Computer proficiencies including Microsoft Office (Word, Excel, Access, Outlook, Visio, Onenote, Teams, etc.) and experience with other program functions (workflow, eligibility, claims, etc.)

Ability to lead and be a good role model, influence change, shape and initiate work with colleagues across the organization and external (care systems, community collaborations, and vendors) to achieve department goals

Ability to provide leadership based on teamwork, commitment & creative linkages with organizational business units, external vendors and care system representatives

Excellent written and verbal communication skills with all levels of the organization

Knowledge of computer applications, such as Microsoft Office, Microsoft Project and Vision, Access, and familiarity with using database systems

Managing/Delegating/Measuring Work: Ability to develop and assign clear, appropriate objectives, accountabilities and measures working within cross functional workstreams. Ability to monitor and report progress; identify and address barriers

Quality Focus: Commitment to continuous quality improvement in all aspects of work. Skilled user of quality tools and techniques

Experience setting expectation and direction for program delivery