Clinical Program Manager
About The Position
Responsible for managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams; including such activities as organizing and publishing agendas, documenting minutes, maintaining work plans and monitoring open action items. Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim, including developing work plans, workflows, policies and procedures, and serving as workgroup leader when appropriate in order to execute initiatives. Serves as project leader for cross functional initiatives that are intended to drive performance improvement engaging across functional teams as needed to ensure effective communication of project requirements, as well as tracks progress of action plans. Facilitates the development of clinical reports and the delivery of data to key provider partners; as well as develops internal reports to demonstrate progress. Performs detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives. May use project management software to support initiatives. Performs other duties as assigned. Complies with all policies and standards. The Clinical Program Manager is responsible for identifying, managing and tracking clinical, quality, correct coding, documentation and data submission projects that advance the objectives of the Health Plan's strategic goals. The Clinical Program Manager facilitates the development of internal and external reports and the delivery of data as needed to support and monitor the action plans to accomplish the Triple Aim: 1) to improve member experience, 2) improve the quality of care and 3) to reduce health care costs.
Requirements
- Must live in Indiana
- Bachelor’s Degree in Nursing, International Medical Graduate, Master’s Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) or equivalent experience
- Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations
- Experience analyzing and presenting data to drive outcomes
- Experience making presentations in group settings
- At least two years project management experience of managing a project at any level at a medical group, IPA or health plan setting
Nice To Haves
- Indiana (MHS) Medicaid experience preferred
- Clinical RN Highly preferred
- Understanding clinical pathway
- Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred
Responsibilities
- Managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams
- Organizing and publishing agendas, documenting minutes, maintaining work plans and monitoring open action items
- Analyzing data and developing and implementing key interventions to support the Triple Aim
- Developing work plans, workflows, policies and procedures
- Serving as workgroup leader when appropriate in order to execute initiatives
- Serving as project leader for cross functional initiatives that are intended to drive performance improvement
- Engaging across functional teams as needed to ensure effective communication of project requirements
- Tracking progress of action plans
- Facilitating the development of clinical reports and the delivery of data to key provider partners
- Developing internal reports to demonstrate progress
- Performing detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives
- Using project management software to support initiatives
- Performing other duties as assigned
- Complying with all policies and standards
- Identifying, managing and tracking clinical, quality, correct coding, documentation and data submission projects that advance the objectives of the Health Plan's strategic goals
- Facilitating the development of internal and external reports and the delivery of data as needed to support and monitor the action plans to accomplish the Triple Aim
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
