Program Manager

Program Manager

CalOptima

CalOptima Health is seeking a highly motivated an experienced Program Manager to join our team. The Program Manager (Quality Improvement) will provide oversight, coordination and staff support to the Quality Improvement (QI) department in the areas of National Committee for Quality Assurance (NCQA) Accreditation, as well as quality requirements for the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS). The incumbent will lead CalOptima Health's health plan and health equity accreditation efforts to ensure CalOptima Health achieves its renewal accreditation. Specifically, the incumbent will work to enhance and strengthen CalOptima Health's quality infrastructure, including program, policy, contract compliance and statutory and regulatory obligations with NCQA, DHCS and CMS. The incumbent will require the ability to complete a variety of detailed analyses, including the impact of accreditation and policy changes from the NCQA, the state of California and the federal government, communicating these changes with QI leadership and affected areas. The incumbent will lead and manage projects and other assignments in the QI department, including those relating to the quality program, workplan and evaluation. The incumbent will interact with CalOptima Health's leadership, state and federal regulatory agencies, as needed.

Position Information:

• Department: Quality Improvement
• 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
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Leads CalOptima Health through the NCQA Health Plan and Health Equity accreditation process and renewals and provides leadership to all business areas to ensure standards are known and met.
  • Leads and facilitates NCQA regulatory audits and audit readiness activities for QI department.
  • Stays current on NCQA accreditation standards as well as local, state and federal health care environment; identifies issues and communicates areas that may impact CalOptima Health's QI programs.
  • Ensures all NCQA related policies are reviewed and updated, as needed, annually. Works directly with regulatory and compliance to ensure submissions are reviewed timely and with legal review.
  • Engages and collaborates with all external NCQA and regulatory related vendors/organizations, including but not limited to NCQA and NCQA consultants, to ensure standards are known and met and accreditation surveys are submitted accurately and timely.
  • Initiates and maintains contact with key business owners to ensure proper submission of required documentation for the accreditation and renewal survey and regulatory audits.
  • Designs and develops process improvements for the QI department to ensure the annual QI program, workplan and evaluation are monitored and executed as planned.
  • Represents QI at various CalOptima Health committee meetings such as the Quality Improvement Health Equity Committee (QIHEC) and its related subcommittees, as well as the Health Network Forum and the Joint Operation meetings with health networks.
  • Designs and develops process improvements for the QI department as the one-stop shop for regulatory information.
  • Engages and collaborates with both internal and external audit and oversight departments to ensure that NCQA standards are met.
  • Manages the accurate and timely submission of regulatory filings and reporting requirements on an ongoing basis.
    
    
• 15% - Administrative Support
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Works with all CalOptima Health departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message.
  • Researches national, state and local health policy issues that may impact CalOptima Health's mission, vision and strategic goals.
  • Leads and facilitates the NCQA Steering Committee meeting.
  • Represents QI department in various internal and external meetings.
  • Provides QI program support to QI managers and other team members, assuring PQI, Credentialing, FSR and PARS processes are compliant with regulatory or audit and accreditation requirements.
    
    
• 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

• Bachelor's degree in a healthcare or related field required.
  
• 3 years of experience working with health care delivery systems and/or in a public agency serving the related population or equivalent required.
  
• 3 years of experience in program and/or project management.
  
• 2 years of experience successfully managing and achieving NCQA accreditation for a health plan or equivalent required.
  
• 2 years of experience within managed care and quality management or equivalent 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:

• 2 years of experience with outreach and public speaking/public relations.

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 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.

Physical Requirements (With or Without Accommodations):

• 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

Work Environment:

If located at the 500, 505 Building or a remote work location:

• 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.

About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving 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. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About our Benefits & Wellness options:
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 Monday or 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. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.

IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 1, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.

Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal 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 at (714) 246-8400 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.


To apply, please visit: https://jobs.caloptima.org/jobs/program-manager-505-city-parkway-west-california-united-states







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