Overview
Skills
Job Details
Program Manager, Sr. (Provider Operation)
Job Description
Department(s): Provider Data Management Services
Reports to: Director II
FLSA status: Exempt
Salary Grade: M - $85,000 - $141,086
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Monday, March 18, 2024 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
About CalOptima Health
Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health!
About the Position
Under the guidance and leadership of the Director of Provider Data Management Services, the Program Manager Sr (Provider Operation) will lead the program development and continuous operation within the Provider Data Management Services department, including the Network Adequacy, provider life cycle operations and regulatory programs impacting the department. The incumbent will be responsible for the end to end of development, implementation and monitoring of their assigned program. The incumbent will develop project work plans, research, organize, and synthesize critical data and information to support strategic decision-making. The incumbent will also be responsible for preparing presentations, briefing documents and data reports and presenting findings to management. The incumbent will facilitate meetings, workgroups and committees to communicate updates within the organization and issue resolution. The incumbent will be expected to work independently.
Duties & Responsibilities:
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.
Formulates and proposes recommendations and options to address new requirements and organization needs with moderate guidance.
Ensures assigned programs meet regulatory requirements and operational needs, works with internal departments and external stakeholders to complete deliverables and meet program Key Performance Indicators.
Participates in compliance and operational meetings and attends external info sessions to stay informed.
Leads the planning, implementation and management of various initiatives and activities in collaboration with management and other CalOptima Health departments.
Executes compliance and policy requirements as mandated, works within the department to ensure timely and accurate implementation.
Owns assigned program, serves as subject matter expert and conducts ongoing review and analysis to ensure compliance, efficiency and overall success.
Supports vendor management activities and works with vendors and leadership to ensure continuous alignment with business needs and strategies.
Tracks and monitors the impact and success of programs.
Produces documentation, summaries, impact analysis and reports for department operations, audits and responses to regulators.
Coordinates workgroup and committee meetings as needed.
Presents regular and organized program updates to all staff levels and regulators.
Stays current on the local, state and federal health care environment to identify public policy and market trends that may impact CalOptima Health's provider programs and/or mission.
Completes other projects or duties as assigned.
Experience & Education:
Bachelor's degree required.
5 years of experience in program development, including using data-driven decision making in program planning and implementation required.
2 years of experience working with policies/regulatory requirements (i.e. impact analysis, report submission, requirements documentation, etc.) required.
1 year of experience working with data analytics/reporting 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.
Preferred Qualifications:
Project Management certificate.
1 year of experience and aptitude for working in a highly matrixed, mission-driven organization.
Experience working with vendors/vendor management.
Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.
Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal employment 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 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.
Job Location: Orange, California
Position Type:
To apply, visit apptrkr.com/5149639
Copyright 2022 Jobelephant.com Inc. All rights reserved.
jeid - 8cd9f528191dd344a38d5601c74b967a