X - As Needed - Program Manager, PHM and Clinical Operations

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

Benefits offered by this job

Partial Telework

Comprehensive benefits package

CalPERS pension program

Job summary

CalOptima Health is seeking a Program Manager for Population Health Management and Clinical Operations. This role supports PHM initiatives, coordinates regulatory alignment with NCQA and CMS, and ensures program tasks are delivered on time. Partial telework is approved with in-state travel to the Orange, CA office as needed.

The role emphasizes collaboration with providers, community partners, and stakeholders to close member care gaps and enhance engagement, within a mission-driven environment.

Qualifications

• Bachelor's degree in public health or related field (or equivalent experience).
• 3 years of experience in program development and implementation in healthcare/managed care.
• Must have transportation means for travel about 5% of the time.

Responsibilities

• Coordinate PHM initiatives and program design with DHCS strategy.
• Develop KPI dashboards and supporting reports for leadership.
• Collaborate with NCQA, CMS and other agencies on regulatory alignment.

Skills

Public health knowledge

Project management

Regulatory compliance

Education

Bachelor's degree in public health or related field

Tools

Microsoft Office

Job description

Join Us in this Amazing Opportunity

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.

The Team You’ll Join

We are hoping you will join us as a X - As Needed - Program Manager, PHM and Clinical Operations and help shape the future of healthcare where you’ll be an integral part of our Clinical Operations Program Support 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.

The Program Manager will play a vital role in the program design, development, implementation and support of Population Health Management (PHM) initiatives related to the Department of Health Care Services (DHCS) PHM Strategy. You will be responsible for coordination, implementation, execution and completion of tasks supporting PHM program development. You will oversee PHM strategy related interventions and documentation, including specific activities that are related to National Committee for Quality Assurance (NCQA) standards toward accreditation. You will support closing member care gaps and improving engagement among member and Primary Care Provider (PCP). You will interact with regulatory and compliance and state and federal regulatory agencies and CalOptima Health’s leadership as needed. Additionally, the incumbent will support other CalOptima Health staff on various member and provider initiatives. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team

• 90% - Program Support
  • 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.
  • Takes ownership of end-to-end operational and program initiatives, including scope, plan, timeline and follow-through.
  • Manages various PHM programs, including innovation pilots consistent with the DHCS PHM strategy.
  • Coordinates between Clinical Operations and other department staff on activities supporting PHM enterprise-wide efforts for DHCS, Centers for Medicare & Medicaid Services (CMS), Healthcare Effectiveness Data and Information Set (HEDIS) measures, NCQA and other agencies as they align with priorities set by leadership.
  • Manages cross-functional projects and assignments in the Clinical Operations department to improve member service participation rate and provider compliance, such as ensuring that the Initial Health Appointment (IHA) objectives are met.
  • Prepares workflows, key performance indicator (KPI) dashboards and reports.
  • Monitors program progress, identifies risks and issues, develops resolutions and ensures adherence to program work plans, timelines and deliverables.
  • Partners with subject matter experts to review data sources, evaluate new initiatives, formulate conclusions and make recommendations for leadership consideration.
  • Assists leadership in the write up and bookmarking of documents used for audits and other regulatory agency reporting submissions.
  • Identifies and manages identification, data management and collaborates with Information Technology, Finance, Internal Audit and Quality Analytics departments to obtain relevant data to strategize and plan.
  • Reviews and assists with updating business regulatory letters in the Medical Management System.
  • Maintains current knowledge on the local, state and federal health care environment, identifying issues that may impact CalOptima Health’s medical management programs.
• 10% - Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor’s degree in public health, health administration or related field PLUS 3 years of experience in program development and implementation, including strategic planning for a start-up program and evaluating evidenced-based programs required, preferably in the health care industry or a managed care environment; 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.
• Have access to means of transportation for work away from the primary office approximately 5% of the time required.

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 and aptitude for 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.