Provider Data Management ServicesReports to:
Director, Provider Data Management ServicesFLSA status:
L - $77,000 - $127,094 About CalOptima Health
CalOptima Health 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 Health.About the Position
The Program Manager (PM) will be responsible to lead programs to analyze, monitor and improve provider data operations activities and programs across all lines of business. The incumbent will be responsible for the beginning to end success of assigned programs that may include Network Adequacy, Network Certification, Provider Directories and Regulatory Compliance. The incumbent will be analytical and interpret regulatory requirements, provide support to teams and ensure accurate and timely report submission. The incumbent will work closely with internal departments and health networks to operationalize required activities, document processes and develop a plan for ongoing monitoring.Duties & Responsibilities:
Experience & Education:
- 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.
- Leads the planning, implementation and management of department initiatives and activities and works collaborative with impacted business departments.
- Acts as a liaison and works with the Office of Compliance department to analyze, track, implement and ensure delivery of regulatory requirements impacting the Provider Data Management Services functional areas.
- Facilitates regulatory, operational and technical requirements discussions and ensures timelines and deliverables with internal teams, third party vendors and health networks.
- Monitors regulatory requirements around programs impacting provider data operations that may include data accuracy, provider directories, network adequacy, and data migration.
- Conducts data quality checks, identifies risks, gaps and resolutions.
- 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.
- 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.
- Provides recommendations to policies and procedures, related to assigned projects and programs.
- 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 health care environment to identify public policy and market trends that may impact CalOptima Health's provider programs and/or mission.
- Completes other projects or duties as assigned.
- Bachelor's degree in a health-related field required.
- 3 years of experience in program development, including strategic planning for a start-up program and implementing the program and evaluating evidenced-based programs required.
- 3 years of experience working in a health plan or Independent Physician Association (IPA)/medical group required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
Physical Demands and Work Environment:
- Master's degree in Health Administration or related field.
- Project Management certificate.
- Project management experience.
- Experience working with provider network operations.
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Physical demands: Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case while traveling, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.
About our Benefits & Wellness options:
- Work Environment: Employee must be able to work in an office environment with moderate noise levels and controlled office temperatures.
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health 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 Health 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.
Job Location: Orange, California
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4252Copyright ©2022 Jobelephant.com Inc. All rights reserved.
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