Program Manager (Provider Network)

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.

More About the Opportunity

We are hoping you will join us as a Program Manager, Provider Network - Covered California and help shape the future of healthcare where you'll be an integral part of our Provider Relations 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 Full 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 (Provider Network) will play a vital role in the program design, development and implementation of programs/benefits and serve as the liaison among internal departments, health networks and delegates. You will be responsible for coordinating efforts and resources to ensure health network and delegated entity are compliant with all CalOptima Health and regulatory requirements, which involves interacting and collaborating with all levels of CalOptima Health staff and stakeholders, including the public, and representatives of other agencies to identify issues/information needs and recommending solutions to optimize business decisions and operations. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 75% - 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.
• Provides program support and coordination for end-to-end operations and interdependencies ensuring alignment with departmental goals and priorities.
• Monitors program progress, identifies risks and issues, develops resolutions and ensures adherence to program work plans timelines and deliverables.
• Coordinates cross-functional efforts with the CalOptima Health Regulatory Affairs and Office of Compliance department and business owners to implement program, reporting and other changes and communicates with stakeholders and project management to implement such changes or related operational issues.
• Develops and maintains workflows, procedures and/or policies with the support of management and recommends improvements to ensure timely and effective outputs.
• Acts as liaison with health networks and delegates during regulatory, CalOptima Health and other audits.
• Coordinates communications with health networks and delegates, including notifications of operational changes, regulatory updates and audit announcements and deliverables.
• Partners with subject matter experts to review data sources, evaluate new initiatives, develop summary reports, formulate conclusions and make recommendations for leadership consideration.
• Makes moderate to significant improvements in processes, systems or products to enhance performance of the job area.
• Conducts research and analysis on program initiatives, regulatory requirements and industry trends to identify potential impacts to health care initiatives or new programs.
• Tracks and monitors multiple concurrent initiatives to ensure the department successfully meets project parameters and targets.
• Prepares program documentation, including workflows, procedures, presentations and detailed reports for internal and external stakeholders.
• Assists in the development and review of policies and procedures that impact health networks and delegates.
• Stays current on the health care marketplace, local, state and federal health care environment, identifying issues that may impact CalOptima Health's health networks and delegates.

• 20% - Administrative Support

• Provides guidance and support to staff regarding standards, organizational understanding and relationship building to promote successful delivery of projects.
• Supports management with project workgroup and marketplace activities.
• Facilitates and leads program related meetings, ensuring clear documentation of decisions, action items and follow-up in these meetings.

• 5% - Other

• Completes other projects and duties as assigned., * Develop rapport and establish and maintain effective working relationships with CalOptima 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 computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment., * Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare., We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.

• Bachelor's degree in public health, healthcare, business or related field PLUS 3 years of program development or program/project management experience in a health care delivery systems and/or public agency serving related populations 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.

You'll Stand Out More If You Possess the Following:

• Managed care operations experience.
• 2 years of experience and aptitude for working in a highly matrixed, mission-driven organization., * Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You'll enjoy competitive compensation for this role.

• Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947). o The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.

• This position is approved for Full Telework (If the position is Telework, it is eligible in California only)
• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:

• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.