Program Manager - Quality Initiatives

Program Manager – Quality Initiatives – Cal Optima

Join to apply for the Program Manager - Quality Initiatives role at Cal Optima.

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.

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 coordinate, monitor and complete tasks supporting the development of quality programs and initiatives. You will monitor cross‑functional projects and other assignments, including those related to department efficiency, to ensure department strategic objectives and initiatives are met.

You will interact with Cal Optima Health's executives and management, legal counsel and state and federal regulatory agencies. Additionally, you will support Cal Optima Health staff on related projects as needed. The role will support a stronger, more equitable health system.

• 80% – Program Management
  • 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.
  • 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.
  • Assists with monitoring 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.
  • 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 Cal Optima Health's quality program and work plan.
• 15% – Administration 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.
  • 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 Cal Optima Health's departments in response to inquiries, problem‑solving and promoting Cal Optima Health's mission and message.
• 5% – Other
  • Completes other projects and duties as assigned.

• Bachelor's degree in health care or a related field PLUS 3 years of related work experience in program development, program/project management or quality metrics analysis and improvement required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the…