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Steam Library > Right Click Fallout 4 > Local Files > Verify Integrity of Game Cache
Some of the files aren't generated by Steam until you run it the first time to complete the installation.
^ This!
If you mean the opening garage scene, it should.
If you just opened the launcher and never hit play, might not.
Sounds like your classic "Windows gets pissy if it isn't run as an administrator" issue, though I can't tell you whether it's the Fallout executable or the NMM that is giving you fits.