Program Manager (Provider Relations) (Orange)

Program Manager (Provider Relations)

CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto Better. Together. is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.

Job Summary

The Program Manager leads the development and implementation of special projects, programs and new initiatives for Provider Relations. The incumbent assists with implementations of programs with departmental and organizational-wide impact and interacts with all levels of staff, providers and external stakeholders. Responsible for all aspects of a project throughout its lifecycle including, but not limited to the scope, schedule, documentation, coordination, provider education and training, resources, quality, cost and change. Project assignments may be within the Provider Relations or Network Operations department or may involve working at large in the organization and externally with providers and community stakeholders.

Position 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.

Develops and implements special projects, programs and new initiatives in a cross-functional capacity.

Manages multiple small to medium sized projects under tight timelines simultaneously.

Researches specific policy issues, regulatory / legislative mandates operational improvements, analyzes options, develops and presents recommendations, and documents decisions regarding the policy and financial implications of certain major initiatives for Provider Relations.

Completes statement of work and work breakdown structure for projects and business plans for all lines of business.

Participates in the department's fiscal year strategic planning process; evaluates and carries out departments' fiscal year strategic plan.

Writes and makes recommendations to policies and procedures, and ensure knowledge of same, related to assigned projects and programs.

Manages and coordinates the CalOptima Provider Manual for all lines of business to ensure information is current with regulatory language and requirements.

Provides analytical support and technical expertise on requests for information from management, and other staff regarding provider related issues and trends.

Stays current on the local, state, and federal healthcare environment to identify public policy and market trends that may impact CalOptima's provider programs and / or mission.

Builds, maintains, and enhances relationships with key internal and external stakeholders.

Ensures Provider Relations and Network Operations materials posted on the CalOptima website are current.

Presents processes and / or proposals as required.

Other projects or duties as assigned.

Possesses the Ability to :

Work independently or in a team environment.

Establish and maintain effective working relationships with CalOptima leadership and staff.

Communicate clearly and concisely, both verbally and in writing.

Analyze and make recommendations regarding provider related issues.

Evaluate data, manipulate spreadsheets, creates reports and perform quantitative analysis.

Utilize computer and appropriate software (e.g., Microsoft Office : Excel, Outlook, PowerPoint, Word) and job-specific applications / systems to produce correspondence, charts, spreadsheets, and / or other information applicable to the position assignment.

Work in a dynamic environment with both short-term and long-term deadlines.

Experience & Education :

Bachelor's degree in a health-related field or related area; or equivalent work experience required.

3 years of experience working in a health plan or IPA / medical group required.

Preferred Qualifications :

Project Management certificate and / or Master's degree in Health Administration preferred.

Prior direct project management experience preferred.

Experience working with provider network operations preferred.

Knowledge of :

Principles and practices of health care, health care systems, health plan operations and strategies.

Medi-Cal and Medicate benefits and regulations.

Techniques of program and policy development, administration and coordination.

Department(s) : Provider Relations

Reports to : Manager of Provider Relations

FLSA status : Non-Exempt

Salary Grade : L - $37.02 - $57.64 ($77,000 - $119,900)

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion / religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.