Program Manager, Quality Initiatives

CalOptima Health Careers; Orange (CA); Hybrid; USD 78,000 - 125,000; Full time

Benefits offered by this job

Partial Telework

Comprehensive benefits

CalPERS pension program

PTO program

Tuition Reimbursement

Professional development opportunities

Flexible scheduling

Job summary

CalOptima Health is seeking a Program Manager, Quality Initiatives to join the Quality Analytics team. The role focuses on designing, implementing, and evaluating quality programs that improve member health outcomes and drive value-based care across our networks.

You will coordinate with executives, providers, and regulators while contributing to P4V initiatives and NCQA alignment. Partial telework is approved with in-office presence in Orange, CA two days per week.

Qualifications

• Bachelor’s degree in health care or related field plus 3 years of experience in program development, program/project management, quality improvement or provider engagement.

Responsibilities

• Collaborate with leadership to design, implement and evaluate quality programs aligned to HEDIS, MCAS and CMS STARs.
• Lead end-to-end program initiatives with scope, timeline and budget management.
• Develop KPIs and reports for leadership updates and program performance.
• Coordinate with providers, health networks and stakeholders on quality measures.
• Monitor regulatory requirements and drive continuous quality improvement across programs.

Skills

Program development

Program/project management

Quality improvement

Provider engagement

Education

Bachelor's degree in health care

Tools

Microsoft Office

Data analysis tools

Quality reporting systems

Job description

Join Us in this Amazing Opportunity

The Team You’ll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Program Manager, Quality Initiatives and help shape the future of healthcare where you’ll be an integral part of our Quality Analytics team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

Under the general direction of the Manager Quality Analytics, the Program Manager (Quality Initiatives) will collaborate and coordinate with leadership to design, implement and evaluate quality programs. You will be responsible for coordination, implementation, execution and completion of tasks supporting the development of quality programs and initiatives. You will monitor cross functional projects and other assignments, including those relating to department efficiency to ensure department strategic objectives and initiatives are met. You will interact with CalOptima Health’s executives and management, legal counsel and state and federal regulatory agencies. Additionally, you will support CalOptima Health staff on related projects as needed. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 80% - Program Management
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Supports with program design, development and implementation of quality programs impacting but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), Managed Care Accountability Sets (MCAS) and Centers for Medicare & Medicaid Services (CMS) STARs quality measures consistent with the quality program and workplan.
  • Takes ownership of end-to-end operational and program initiatives, including scope, plan, timeline and follow-through.
  • Drafts workplans for assigned projects and assignments and manages the scope, schedule, budget and quality of the project.
  • Leads performance and quality improvement projects, Plan Do Study Act or other formats.
  • Supports National Committee for Quality Assurance (NCQA) accreditation standard initiatives or projects and provides analysis and evaluation of related activities as needed.
  • Monitors strategic program development, root cause analysis and impact analysis and coordinates collaborative and quality innovation pilots.
  • Reviews evidence-based literature for best practices to incorporate into strategy.
  • Produces slide decks, documentation, summaries and other reports for leadership as needed.
  • Supports subject matter experts to review data sources, evaluate new initiatives, develop summary reports, formulate conclusions and make recommendations for leadership consideration.
  • Participates in meetings with providers, health networks and hospital partners to review performance for quality measures and CalOptima Health’s pay-for-value (P4V) programs. Manages the implementation of quality improvement grant programs that utilize unearned incentive dollars.
  • Develops and oversees the process of written tools for programmatic use, including program plans, surveys and evaluation instruments.
  • Establishes key performance indicators (KPIs) and metrics to monitor project progress and performance, providing regular updates to senior management as needed.
  • Collaborates with other departments in the development of program measures of success and outcome reports for programs.
  • Maintains current knowledge of applicable regulations or clinical guidelines related to program development.
  • Stays current on the local, state and federal health care environment and identifies issues that may impact CalOptima Health’s quality program and workplan.
• 15% - Administration Support
  • Reviews and assists in updating policies and procedures to ensure knowledge related to assigned programs and projects is kept up to date.
  • Works with all CalOptima Health departments in response to inquiries, problem-solving and promoting CalOptima Health’s mission and message.
• 5% - Other
  • Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor’s degree in health care or a related field required PLUS 3 years of experience in program development, program/project management, quality improvement or provider engagement required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

You’ll Stand Out More If You Possess the Following:

• Master’s degree in public health, health administration or related field.
• 1 year of experience working in a highly matrixed, mission-driven organization.

What the Regulatory Agencies Need You to Possess?

• N/A

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You’ll enjoy competitive compensation for this role.
  • Our current hiring range is: Pay Grade:311 - $77,863 - $124,581 ($37.43 - $59.8947).
    • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Partial Telework(If the position is Telework, it is eligible in California only)
• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
  • A generous PTO program
  • A quality work life balance
  • Various wellness programs
  • Tuition Reimbursement
  • Professional development opportunities
  • Career development opportunities
  • Flexible scheduling
  • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at [phone] if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.