Clinical Program Manager ePA

Clinical Program Manager ePA

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaborationbecause success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This Program Manager will oversee initiatives within Medica's Clinical Services Optimization division, with a primary focus on the electronic prior authorization (ePA) business delivery. The Program Manager is accountable for leading program planning, gathering and documenting business requirements, ensuring seamless daily operations of ePA, and driving process improvements. This role coordinates and guides cross-functional teamsincluding network, Technology, and claims operationsfrom concept and requirements through delivery, ongoing maintenance, and validation. The Program Manager is responsible for operationalizing regulatory and business requirements to support both compliance and strategic growth initiatives. Serving as the ePA clinical documentation system subject matter expert, this leader acts as the primary liaison among Clinical Services, other business units, Medica IT, clinical platform vendors, and reporting teams, ensuring alignment of program objectives and successful implementation of solutions. Performs other duties as assigned.

Key Accountabilities

• Program Manager for ePA delivery
• 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
• Expert Oversight of Clinical Documentation System as it relates to cross functional ePA delivery
• 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
• Cross functional Collaboration
• 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

Required Qualifications

Skills and Abilities

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations : Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $98,400 - $168,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $98,400 - $147,525. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and / or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US : Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.