X Program Manager, PHM and Clinical Operations

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 X
- As Needed
- Program Manager, PHM and Clinical Operations and help shape the future of healthcare where you’ll be an integral part of our Clinical Operations Program Support 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 will play a vital role in the program design, development, implementation and support of Population Health Management (PHM) initiatives related to the Department of Health Care Services (DHCS) PHM Strategy. You will be responsible for coordination, implementation, execution and completion of tasks supporting PHM program development. You will oversee PHM strategy related interventions and documentation, including specific activities that are related to National Committee for Quality Assurance (NCQA) standards toward accreditation.

You will support closing member care gaps and improving engagement among member and Primary Care Provider (PCP). You will interact with regulatory and compliance and state and federal regulatory agencies and Cal Optima Health’s leadership as needed. Additionally, the incumbent will support other Cal Optima Health staff on various member and provider initiatives. Together, we are building a stronger, more equitable health system.

• 90% - 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.
  • Takes ownership of end-to-end operational and program initiatives, including scope, plan, timeline and follow-through.
  • Manages various PHM programs, including innovation pilots consistent with the DHCS PHM strategy.
  • Coordinates between Clinical Operations and other department staff on activities supporting PHM enterprise-wide efforts for DHCS, Centers for Medicare & Medicaid Services (CMS), Healthcare Effectiveness Data and Information Set (HEDIS) measures, NCQA and other agencies as they align with priorities set by leadership.
  • Manages cross-functional projects and assignments in the Clinical Operations department to improve member service participation rate and provider compliance, such as ensuring that the Initial Health Appointment (IHA) objectives are met.
  • Prepares workflows, key performance indicator (KPI) dashboards and reports.
  • Monitors program progress, identifies risks and issues, develops resolutions and ensures adherence to program work plans, timelines and deliverables.
  • Partners with subject matter experts to review data sources, evaluate new initiatives, formulate conclusions and make recommendations for leadership consideration.
  • Assists leadership in the write up and bookmarking of documents used for audits and other regulatory agency reporting submissions.
  • Identifies and manages identification, data management and…