Sr Program Manager Operational Automation

About the Role

Key Responsibilities

• Develop and operationalize an automation roadmap aligned to PHSO managed care objectives, focusing on delegated operations, quality, analytics, and care coordination.
• Lead the end-to-end delivery of automation initiatives, including needs assessment, business case development, stakeholder alignment, risk management, and sustainment planning.
• Collaborate with IT and business SMEs to design and implement workflow automations within EZCAP to improve efficiency, reduce manual rework, and streamline data handoffs.
• Identify high-impact manual processes across departments such as Claims, UM, Credentialing, and Provider Data, facilitating automation readiness assessments and future-state process modeling.
• Evaluate, pilot, and deploy automation technologies such as RPA, low-code platforms, and AI solutions in collaboration with IT, managing vendor relationships for successful delivery and scalability.
• Serve as a strategic partner to business and technical leads, ensuring automation goals are aligned with operational needs, compliance requirements, and technology infrastructure.
• Define KPIs and dashboards to measure the performance and ROI of automation programs, providing regular updates and presentations to senior leadership.
• Establish governance protocols to ensure all automation projects comply with internal policies, DMHC/Knox-Keene regulations, HIPAA, and audit requirements.

Requirements

• Minimum of 8 years in program or operations management, with 5+ years leading automation efforts in healthcare or delegated managed care settings.
• Bachelors 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.

Nice to Have

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

Qualifications

• Bachelor's degree in relevant field (Business Administration, Healthcare Administration, Computer Science, or related).
• Minimum of 8 years in program or operations management.
• At least 5 years of experience leading automation efforts in healthcare or delegated managed care.

Benefits & Perks

• Outstanding Total Rewards package with competitive pay and flexible Health & Welfare benefits.
• Cafeteria-style benefit program including medical, dental, and vision plans for employees and dependents.
• Health Spending Account (HSA), Life Insurance, and Long Term Disability.
• 401k retirement plan with employer match.
• Paid Time Off and Sick Leave.