Program Manager, Medicare Insights and Operations

Program Manager, Medicare Insights and Operations

Cal Optima

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.

We are hoping you will join us as a Program Manager, Medicare Insights and Operations and help shape the future of healthcare where you’ll be an integral part of our Operations Management 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 for Medicare Insights and Operations will play a vital role in the program design, development, implementation and support of department initiatives and programs for the Medicare line of business. You will deliver high-impact analytics and insights that drive informed decision-making across the organization. You will lead analytical initiatives from start to finish, including defining the problem, designing the solution and seeing it through to delivery and adoption turning insights into action.

You will complete hands‑on project management responsibilities to ensure analytical solutions are delivered on time, within scope, and aligned to business priorities. You will interact and collaborate with all levels of Cal Optima Health's staff and stakeholders in support of programs and related projects. Together, we are building a stronger, more equitable health system.

• 50% - Analytics & Insights
  - 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.
• Extracts, structures, and analyzes operational data across the Medicare Advantage business to answer leadership questions and surface trends, risks, and opportunities.
• Builds and maintains recurring dashboards, scorecards, and performance views.
• Partners with subject matter experts to review data sources, evaluate new initiatives, develop summary reports, formulate conclusions and make recommendations for leadership consideration.
• Produces ad hoc analyses to support decisions on retention, growth, member experience, and regulatory performance.
• Tracks and monitors multiple concurrent initiatives to ensure the department successfully meets project parameters and targets.
• Translates unclear business questions into clear analyses and translates findings into plain-language recommendations for non-technical stakeholders.
• 45% - Programs & Initiatives
  - Leads program development and implementation and provides oversight for various programs and project plans for the Medicare line of business.
• Takes ownership of end-to-end operational initiatives including scope, plan, timeline, stakeholders, and follow-through.
• Operates cross-functional work teams and collaborates with teams to translate analytic insights into impactful improvements.
• Supports process-improvement efforts, documenting current-state workflows collaborate in the design the future state.
• Prioritizes and manages multiple work streams independently under tight deadlines to support near-term needs with long-term initiatives.
• 5% - Other
  - Completes other projects and duties as assigned.

• Bachelor's degree in a related field PLUS 3 years of experience in operations, data analytics, project management and/or program management required, preferably in Medi-Cal Managed Care, Medicare,…