CalOptima · 8 hours ago
Program Manager (Provider Data Operations)
Orange, CA
Full-time
Hybrid
Mid Level
$78K/yr - $125K/yr
3+ years expCalOptima is a mission-driven community-based organization focused on serving member health with excellence. They are seeking a Program Manager for Provider Data Operations to facilitate the planning, design, and implementation of programs that align with the organization's strategy and improve healthcare access for members.
Non ProfitGovernmentHealthcareHealth Care
Responsibilities
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
Coordinates the planning, implementation and management of department initiatives and activities and works collaboratively with impacted business departments
Acts as a liaison and works with the Regulatory Affairs and Compliance department to analyze, track, implement and ensure delivery of regulatory requirements impacting the Provider Data Operations functional areas
Facilitates end-to-end implementation of regulatory, operational and technical requirement and ensures timelines and deliverables are fulfilled in cooperation with internal teams, third party vendors and health networks
Conducts data quality checks, validates processes against requirements and identifies risks, gaps and resolutions
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
Creates and maintains thorough documentation, including policies and procedures, standard operating procedures (SOPs), job aids and training materials, following best practices for retention and accessibility
Provides analytical support and technical expertise on requests for information from management and other staff regarding provider-related issues and trends
Supports management and leadership by analyzing strategic options and providing data-driven recommendations
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 and duties as assigned
Qualification
Required
Bachelor's degree in a health-related field PLUS 3 years of experience in program development, including strategic planning for a start-up program and implementing the program 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
3 years of experience working in a health plan or independent physician association (IPA)/medical group required
2 years of experience working with data and reports required
Preferred
Master's degree in health administration or related field
Project management certificate
Project management experience
Experience working with provider network operations
Benefits
A comprehensive benefits package
CalPERS pension program and additional retirement packages.
A generous PTO program
A quality work life balance
Various wellness programs
Tuition Reimbursement
Professional development opportunities
Career development opportunities
Flexible scheduling
Company
CalOptima
CalOptima is a county organized health system that provides health insurance programs.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Michael Hunn
CEO
Recent News
Orange County Register
2023-06-21
Orange County Register
2023-05-19
Orange County Register
2023-05-17
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