Note: The job is a remote job and is open to candidates in USA. CalOptima is a mission-driven community-based organization that serves member health with excellence and dignity. The Program Manager, Provider Network - Covered California will be responsible for program design, development, and implementation, serving as a liaison among internal departments and health networks to ensure compliance with regulatory requirements.
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
- Provides program support and coordination for end-to-end operations and interdependencies ensuring alignment with departmental goals and priorities
- Monitors program progress, identifies risks and issues, develops resolutions and ensures adherence to program work plans timelines and deliverables
- Coordinates cross-functional efforts with the CalOptima Health Regulatory Affairs and Office of Compliance department and business owners to implement program, reporting and other changes and communicates with stakeholders and project management to implement such changes or related operational issues
- Develops and maintains workflows, procedures and/or policies with the support of management and recommends improvements to ensure timely and effective outputs
- Acts as liaison with health networks and delegates during regulatory, CalOptima Health and other audits
- Coordinates communications with health networks and delegates, including notifications of operational changes, regulatory updates and audit announcements and deliverables
- Partners with subject matter experts to review data sources, evaluate new initiatives, develop summary reports, formulate conclusions and make recommendations for leadership consideration
- Makes moderate to significant improvements in processes, systems or products to enhance performance of the job area
- Conducts research and analysis on program initiatives, regulatory requirements and industry trends to identify potential impacts to health care initiatives or new programs
- Tracks and monitors multiple concurrent initiatives to ensure the department successfully meets project parameters and targets
- Prepares program documentation, including workflows, procedures, presentations and detailed reports for internal and external stakeholders
- Assists in the development and review of policies and procedures that impact health networks and delegates
- Stays current on the health care marketplace, local, state and federal health care environment, identifying issues that may impact CalOptima Health's health networks and delegates
- Provides guidance and support to staff regarding standards, organizational understanding and relationship building to promote successful delivery of projects
- Supports management with project workgroup and marketplace activities
- Facilitates and leads program related meetings, ensuring clear documentation of decisions, action items and follow-up in these meetings
- Completes other projects and duties as assigned
Skills
- Bachelor's degree in public health, healthcare, business or related field PLUS 3 years of program development or program/project management experience in a health care delivery systems and/or public agency serving related populations 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
- 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
- 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
- Managed care operations experience
- 2 years of experience and aptitude for working in a highly matrixed, mission-driven organization
Benefits
- Full Telework
- A comprehensive benefits package
- CalPERS pension program and additional retirement packages.
- A generous PTO program
- A quality work life balance
- Various wellness programs
- Tuition Reimbursement
- Professional development opportunities
- Career development opportunities
- Flexible scheduling
Company Overview