Program Manager - Issue Management

The Program Manager receives and reviews issues identified by Delivery System Engagement and/or reported by providers, consolidates and removes duplicate submissions, validates and categorizes issues, and routes actionable items to the appropriate operational teams for investigation and resolution. The role maintains end-to-end visibility of reported issues, monitors progress against established timelines, identifies aging or stalled items, facilitates escalation when necessary, and communicates status and resolution information back to Delivery System Engagement.

Duties & Responsibilities

Post-Implementation Issue Intake and Triage

• Serves as the centralized point of intake for post-implementation issues submitted by Network Management.
• Reviews incoming issues for completeness, clarity, and appropriate supporting information.
• Identifies and consolidates duplicate or related issues to prevent redundant investigation by operational teams.
• Categorizes issues by type, business area, severity, provider impact, and other established criteria.
• Distinguishes individual provider-specific issues from broader systemic or implementation-related concerns.
• Routes validated issues to the appropriate operational team for investigation and corrective action.

Issue Tracking and Coordination

• Maintains a centralized post-implementation issue tracker and ensures issue records remain accurate and current throughout the resolution lifecycle.
• Assigns or coordinates ownership with appropriate operational stakeholders.
• Tracks investigation status, corrective actions, target completion dates, dependencies, and final resolution.
• Conducts regular follow-up with operational teams regarding outstanding issues.
• Identifies aging, stalled, high-impact, or recurring issues requiring additional attention or escalation.
• Facilitates cross-functional coordination when resolution requires participation from multiple operational areas.
• Ensures closed issues contain sufficient documentation regarding findings, corrective actions, and resolution.

Monitoring and Trend Identification

• Monitors reported issues following implementation to identify emerging trends, recurring defects, or systemic concerns.
• Identifies clusters of similar provider-reported issues that may indicate a broader operational problem.
• Monitors issue volume, aging, resolution timelines, and other established post-implementation performance indicators.
• Provides visibility into whether implementation-related issues are stabilizing or require additional intervention.
• Supports post-implementation reviews by providing issue trends, resolution data, and lessons learned.

Communication and Reporting

• Serves as the communication bridge between Delivery System Engagement and operational issue owners.
• Provides Delivery System Engagement with timely status updates regarding reported issues, investigations, corrective actions, and resolutions.
• Translates operational findings into clear information that Delivery System Engagement can use when communicating with providers.
• Develops recurring post-implementation status reports and dashboards for Network Management, operational teams, and leadership.
• Communicates significant trends, risks, barriers, and unresolved issues to appropriate stakeholders.
• Facilitates recurring issue-review meetings during designated post-implementation monitoring periods.

Process Governance

• Establishes and maintains standardized processes for post-implementation issue intake, triage, routing, tracking, escalation, and closure.
• Defines clear issue statuses, ownership expectations, escalation criteria, and resolution documentation requirements.
• Partners with Network Management and operational teams to improve the quality and consistency of issue submissions and responses.
• Identifies opportunities to improve post-implementation monitoring based on recurring issues and lessons learned.
• Supports development of standard operating procedures, workflows, reporting tools, and governance practices for post-implementation monitoring.

Minimum Qualifications

• Bachelor’s degree in healthcare administration, business, operations, or a related field preferred, or equivalent relevant work experience in Project Management and Root Cause Analysis (at least 3 years).
• Experience within a health plan, managed care organization, healthcare organization, or similarly complex operational environment.
• Experience working with provider network operations, claims, provider data, configuration, implementation, or health plan operations strongly preferred.
• Experience coordinating cross-functional operational issues and tracking items through resolution.
• Strong organizational and issue-management skills with demonstrated ability to manage multiple concurrent items.
• Ability to identify duplicate, related, and potentially systemic issues from multiple reports.
• Strong written and verbal communication skills.
• Ability to communicate effectively with both operational/technical teams and provider-facing business teams.
• Strong analytical skills with the ability to identify trends and summarize complex operational issues for leadership.
• Experience with issue-tracking, workflow, reporting, or project-management tools preferred.