CHW Program Lead - Compliance & Ops

SCFHP South County Resident Advisory Group; San Jose (CA); On-site; USD 120,000 - 150,000; Full time

Job summary

SCFHP South County Resident Advisory Group is seeking a Program Manager to lead the Medi-Cal Community Health Worker benefit, coordinating with internal teams, external consultants, auditors and providers to ensure compliant operations and effective data reporting.

The role emphasizes program development, workflow optimization, training on eligibility, and cross‑functional collaboration to support care coordination and population health initiatives within the CHW network.

Qualifications

• Bachelor’s Degree in Healthcare, Business, social work or related field, or equivalent experience, training, or coursework.
• Minimum two years of experience in health, community-based social service and/or managed care setting with responsibility for program operations.
• Program management experience.
• Ability to assess training needs and methods, develop training materials and conduct trainings using a variety of techniques based on the audience.
• Ability to direct and manage cross-functional, multi-departmental projects to completion with minimum supervision (R).
• Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities.
• Advanced working knowledge and proficient with Microsoft Suite applications, and the ability to operate all applicable software.
• Ability to use a keyboard with moderate speed and a high level of accuracy.
• Excellent oral and written communication skills, including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments and outside entities over the telephone, in person or in writing.
• Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, and staff.
• Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes.
• Ability to take initiative and exercise good judgment when making decisions within the scope of the position.
• Ability to maintain confidentiality.
• Ability to comply with all SCFHP policies and procedures.
• Ability to perform the job safely with respect to others, to property, and to individual safety.
• Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or event.
• Experience with SQL development language and/or Tableau. (D)

Responsibilities

• Create and lead both the development and operations of the CHW benefit by providing direction for project framing, work plan development and management, business case analysis, user-testing, implementation, and outcome measurement.
• Execute program work plans including engagement of internal departments, vendors, providers and consultants, convening and facilitation of meetings, supporting and validating reporting data, and ongoing monitoring and oversight of all program activities within specific timeframes and meeting designated deadlines.
• Manage workflow, assignments, turn‑around times and follow up for all day‑to‑day CHW referrals and assistance requests and respond in a timely manner to members, internal and/or external entities.
• Monitor and ensure workflows, ongoing programs and projects are in compliance with CMS, DHCS, DMHC and NCQA regulations and guidelines at all times.
• Serve as subject matter expert and SCFHP liaison for engagement with community stakeholders invested in the CHW network, workforce development and implementing the CHW benefit.
• Develop and implement initial and ongoing training on eligibility and access for CHW benefits for SCFHP staff, CHW network providers and delegates in accordance with organizational business requirements, and policies and procedures.
• Develop, expand, and manage a network of contracted providers to meet the demand for the CHW benefit including leading recruitment activities, managing provider capacity and working with certification programs to ensure access for CHW providers.
• Coordinate with and support the case management and IT staff to ensure IT systems address CHW data needs for both required reporting and program evaluation.
• Support and oversee development, approval and monitoring of provider contracts.
• Oversee process for CHW data analytics and the completion and timely, accurate submission of CHW reports including interface with IT and other internal departments.
• Monitor and collaborate with management on SCFHP policies and procedures and workflows that support successful and compliant CHW integration and operations.
• Identify, research and resolve program issues and elevate critical issues, problems and delays to management.
• Provide regular feedback to management on status and outcome of assignments, workflows and training activities with recommendations for operational improvements.
• Oversee process for developing, updating and sharing an inventory of relevant CHW providers and workforce capacity to support care coordination and population health management.
• Participate in meetings and conference calls with regulatory agencies (e.g.., federal, state, county, trade associations), NCQA, SCFHP management, delegates and vendors to obtain and capture requirements and timelines.
• Perform other related duties as required or assigned.

Skills

Program management

Cross-functional collaboration

Communication skills

Microsoft Office

Training development

Data reporting

Regulatory awareness

Project coordination

Education

Bachelor’s Degree in Healthcare, Business, social work or related field

Tools

SQL development language

Tableau

Job description

SCFHP South County Resident Advisory Group is seeking a Program Manager to lead the Medi-Cal Community Health Worker benefit, coordinating with internal teams, external consultants, auditors and providers to ensure compliant operations and effective data reporting.

The role emphasizes program development, workflow optimization, training on eligibility, and cross‑functional collaboration to support care coordination and population health initiatives within the CHW network.