Job Details

Sr Program Manager Operational Automation

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Location: Remote (PST business hours as required)

Position Summary

The Senior Program Manager of Operational Automation will lead the design, implementation, and optimization of enterprise-wide automation initiatives across managed care functional areas supported by the PHSO. This strategic role serves as a critical bridge between operations, IT, and business transformation, accelerating performance through technology-enabled process redesign. The ideal candidate brings a strong command of automation frameworks, EZCAP experience, and deep familiarity with the complexities of delegated services, including claims, utilization management, provider data, and network operations.

Essential Functions

• Enterprise Automation Strategy: Develop and operationalize an automation roadmap aligned to PHSO managed care objectives, with focus areas including delegated operations, quality, analytics, and care coordination.
• Program Execution: Lead the end-to-end delivery of automation initiatives, including needs assessment, business case development, stakeholder alignment, risk management, and sustainment planning.
• EZCAP Automation Development: Collaborate with IT and business SMEs to design and implement workflow automations within EZCAP to improve efficiency, reduce manual rework, and streamline data handoffs.
• Process Design and Optimization: Identify high-impact manual processes across departments such as Claims, UM, Credentialing, and Provider Data. Facilitate automation readiness assessments and future-state process modeling.
• Technology Integration and Vendor Partnership: Evaluate, pilot, and deploy automation technologies such as RPA, low-code platforms, and AI solutions in collaboration with IT. Manage vendor relationships to ensure successful delivery and scalability.
• Cross-Functional Collaboration: Serve as a strategic partner to business and technical leads, ensuring automation goals are aligned with operational needs, compliance requirements, and technology infrastructure.
• Metrics and Reporting: Define KPIs and dashboards to measure the performance and ROI of automation programs. Provide regular updates and presentations to senior leadership on progress, roadblocks, and value realization.
• Governance and Compliance: Establish governance protocols to ensure all automation projects comply with internal policies, DMHC/Knox-Keene regulations, HIPAA, and audit requirements.

Qualifications

• Minimum of 8 years in program or operations management, with 5+ years leading automation efforts in healthcare or delegated managed care settings.
• Bachelor's degree in Business Administration, Healthcare Administration, Computer Science, or related field.
• Experience with Business Process Automation (BPA) tools and processes
• Demonstrated experience working with EZCAP, preferably with workflow automation or integration projects.
• Proficiency with RPA platforms (e.g., UiPath, Automation Anywhere), business process mapping tools (e.g., Visio, Lucidchart), and basic familiarity with scripting or low-code tools.
• Deep understanding of managed care operations and delegated functions (claims adjudication, UM, provider data, etc.).
• Demonstrated ability to lead complex, cross-functional projects with measurable outcomes and stakeholder engagement.
• Strong written and verbal communication skills, with ability to translate technical solutions into business value.

Preferred Qualifications

• Experience within a Management Services Organization (MSO) or Population Health enterprise preferred.
• Lean Six Sigma or process improvement certification preferred.
• Exposure to national platforms such as Innovaccer, Epic Payer Platform, or similar systems preferred.
• Master's degree in Business Administration, Healthcare Administration, Computer Science, or related field preferred.

Pay Range

$52.15 - $77.58 /hour

Note: Portions of the original description contained company-wide boilerplate and extraneous details not essential to the role description were omitted to improve clarity and focus.