Program Manager IV - Clinical Optimization

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 collaboration — because 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 role works within Medica’s Clinical Optimization team, leading strategic initiatives focused on clinical system transformation, automation, and optimization. The Program Manager IV is responsible for driving complex, cross-functional programs that impact clinical platforms such as GuidingCare and Wellframe, translating business strategy into executable plans across people, process, and technology.

This position serves as a key change agent, partnering with business, IT, and vendor stakeholders to deliver enterprise initiatives, improve workflows, and enable scalable operational capabilities. Performs other duties as assigned.

Key Accountabilities

• Strategic Initiative Leadership
• Lead complex, cross-functional initiatives impacting clinical systems (e.g., platform migration, workflow redesign, automation efforts)
• Drive end-to-end delivery from strategy through execution, ensuring alignment to enterprise goals
• Partner with implementation, business, and IT teams to define scope, timelines, and success measures
• Act as primary point of coordination across stakeholders to ensure alignment and progress

• Optimization & Transformation
• Identify and drive opportunities for process optimization, automation, and capability enhancement
• Translate business needs into system-level changes across GuidingCare and integrated platforms
• Support evaluation and adoption of new vendor capabilities and product enhancements
• Lead workflow redesign initiatives to improve efficiency, quality, and scalability

• Cross-Functional Collaboration & Governance
• Collaborate with internal stakeholders, IT partners, and external vendors to deliver integrated solutions
• Ensure alignment between strategic priorities, operational needs, and technical capabilities
• Facilitate prioritization and intake of enhancement requests and track progress to delivery
• Communicate impacts of changes to stakeholders and ensure organizational readiness

• Portfolio & Roadmap Management
• Support development and execution of roadmap for clinical platform enhancements and initiatives
• Monitor program progress, identify risks, and proactively resolve issues or escalate barriers
• Ensure initiatives align with regulatory, compliance, and organizational requirements
• Provide updates and insights to leadership on initiative status and outcomes
  

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 7 years of work experience beyond degree
• Strong ability to lead complex initiatives across multiple stakeholders
• Excellent communication and stakeholder management skills across all organizational levels
• Strong analytical, organizational, and problem-solving abilities
• Ability to balance strategic thinking with execution-level detail
• Demonstrated ability to influence without direct authority and drive outcomes
  
  

Preferred Qualifications

• Experience working with clinical systems (e.g., GuidingCare, Wellframe, UM/CM workflows)
• Experience with vendor-managed platforms and integrations
• Background in healthcare operations, claims, or clinical services
  
  

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 $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. 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.