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CalOptima · 8 hours ago

Program Manager - Quality Initiatives

Orange, CA

Full-time

Hybrid

Mid Level

$78K/yr - $125K/yr

3+ years exp

CalOptima is a mission-driven community-based organization focused on serving member health with excellence and dignity. They are seeking a Program Manager - Quality Initiatives to design, implement, and evaluate quality programs while collaborating with leadership and various stakeholders to enhance healthcare quality and efficiency.

GovernmentHealth CareNon Profit

Comp. & Benefits

Responsibilities

Supports with 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 Centers for Medicare & Medicaid Services (CMS) STARs quality measures, consistent with the quality program and workplan

Leads performance and quality improvement projects, Plan Do Study Act or other formats

Supports National Committee for Quality Assurance (NCQA) accreditation standard initiatives or projects and provides analysis and evaluation of related activities as needed

Assists with monitoring strategic program development, root cause analysis and impact analysis and coordinates collaborative and quality innovation pilots

Reviews evidence based literature for best practices to incorporate into strategy

Produces slide decks, documentation, summaries and other reports for leadership as needed

Develops and oversees the process of written tools for programmatic use, including program plans, surveys and evaluation instruments

Establishes key performance indicators (KPIs) and metrics to monitor project progress and performance, providing regular updates to senior management as needed

Collaborates with other departments 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 and identifies issues that may impact CalOptima Health's quality program and work plan

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 assists in updating policies and procedures to ensure knowledge related to assigned programs and projects is kept up to date

Works with all CalOptima Health's departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message

Completes other projects and duties as assigned

Qualification

Program ManagementQuality ImprovementData AnalysisHealthcare RegulationsProject ManagementMicrosoft OfficeCommunication SkillsCollaborationProblem Solving

Required

Bachelor's degree in health care or a related field PLUS 3 years of related work experience in program development, program/project management or quality metrics analysis and improvement 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