Program Manager

4 weeks ago

Orange, United States CalOptima Full time

**Program Manager**

**CalOptima**

**CalOptima Health** is seeking a highly motivated an experienced **Program Manager** to join our team. Under the general direction of the Director, the Program Manager (Quality Analytics (CMS Stars)) will collaborate and coordinate with leadership to design, implement and evaluate quality programs for the Centers for Medicare & Medicaid Services (CMS) Star Ratings and other similar quality programs. The incumbent will lead, coordinate, monitor and complete tasks supporting the development of quality programs and initiatives. The incumbent will monitor cross functional projects and other assignments, including those relating to department efficiency to ensure department strategic objectives and initiatives are met. The incumbent will interact with CalOptima Health's executives and management, legal counsel and state and federal regulatory agencies. The incumbent will also support CalOptima Health staff on related projects.

**Position Information**:

- Department**:Quality Analytics**:

- Salary Grade**:311 - $77,863 - $124,581 ($37.43 - $59.8947)**:

- Work Arrangement**:Partial Telework**

**This position is eligible for telework in California.***

**Duties & Responsibilities**:

- 80% - Program Support
- Leads 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 CMS Star Rating quality measures consistent with the quality program and workplan.
- Develops and oversees improvement initiatives related to member surveys including Consumer Assessment of Healthcare Providers & Systems (CAHPS) and Health Outcomes Surveys (HOS).
- Collaborates with other departments to monitor and analyze data related to quality improvement measure sets.
- Leads improvement projects in performance improvement project, quality improvement project, Plan Do Study Act (PDSA) or other formats.
- Supports National Committee for Quality Assurance (NCQA) accreditation standard initiatives or projects and provides analysis and evaluation of related activities.
- Leads strategic program development and management, root cause analysis, impact analysis and coordinates collaborative and quality innovation pilots.
- Reviews evidence-based literature for best practices to incorporate into strategy.
- Develops and oversees the process of written tools for programmatic use, including program plans, surveys and evaluation instruments.
- Collaborates with other department analysts 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, identifies issues that may impact CalOptima Health's quality program and workplan. Assists in the development, collection, and reporting of quality incentive programs such as pay for performance and quality withhold program results implemented by DHCS or CMS.- 15% - Administrative 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 helps update policies and procedures and ensures knowledge related to assigned programs and projects. Works with all CalOptima Health's departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message.- 5% - Completes other projects and duties as assigned.

**Minimum Qualifications**:

- Bachelor's degree required.
- 3 years of health care related work experience in program development, including strategic planning for a start-up program, implementing the program and evaluating evidenced-based programs required.
- Experience with CMS Star Ratings, including but not limited to HEDIS, CAHPS, HOS, administrative and pharmacy measures required.
- Experience and aptitude for working in a highly matrixed, mission-driven organization required.
- Experience with value-based contracts and provider incentive programs like pay for performance 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.

**Preferred Qualifications**:

- Master's degree in public health, health administration or related field.

**Required Licensure / Certifications**:

- N/A

**Knowledge & Abilities**:

- 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 ora

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