Program Manager; Provider Data Operations

Program Manager (Provider Data 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 (Provider Data Operations) and help shape the future of healthcare where you'll be an integral part of our Provider Data Operations 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.

You will be responsible for facilitating the planning, design and implementation of programs and initiatives that impact the teams within the Provider Data Operations department. You will review and analyze regulatory and operational requirements and be responsible for full cycle implementation. You will develop a framework for execution, ensuring that programs are aligned with the organization's larger strategy, executed according to requirements and meet the needs of the department.

Together, we are building a stronger, more equitable health system.

• 95% - 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.
• Coordinates the planning, implementation and management of department initiatives and activities and works collaboratively with impacted business departments.
• Acts as a liaison and works with the Regulatory Affairs and Compliance department to analyze, track, implement and ensure delivery of regulatory requirements impacting the Provider Data Operations functional areas.
• Facilitates end-to-end implementation of regulatory, operational and technical requirement and ensures timelines and deliverables are fulfilled in cooperation with internal teams, third party vendors and health networks.
• Conducts data quality checks, validates processes against requirements and identifies risks, gaps and resolutions.
• Completes statement of work and work breakdown structure for projects and business plans for all lines of business.
• Collaborates with other department analysts in the development of program measures of success and outcome reports for programs.
• Creates and maintains thorough documentation, including policies and procedures, standard operating procedures (SOPs), job aids and training materials, following best practices for retention and accessibility.
• Provides analytical support and technical expertise on requests for information from management and other staff regarding provider-related issues and trends.
• Supports management and leadership by analyzing strategic options and providing data-driven recommendations.
• Stays current on the local, state and federal health care environment to identify public policy and market trends that may impact Cal Optima Health's provider programs and/or mission.
• 5% - Completes other projects and duties as assigned.

• Bachelor's degree in a health-related field PLUS 3 years of experience in program development, including strategic planning for a start-up program and implementing the program 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.
• 3 years of experience working in a health plan or independent physician association (IPA)/medical group required.
• 2 years of experience working with data and reports required.

• Master's degree in health administration or related field.
• Project management certificate.
• Project management experience.
• Experience working with provider network operations.

n/a

• Develop rapport and establish and maintain effective working relationships with Cal Optima 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…