Community Health Worker Program Manager

Santa Clara County Health Authority•San Jose, CA

About The Position

The Community Health Worker (CHW) Program Manager develops, implements, and manages the Medi-Cal Community Health Worker benefit. The role works collaboratively with internal and external stakeholders—including consultants, auditors, and providers—to support CHW operational workflows, data and reporting, and the staff and provider/delegated network, ensuring compliance with applicable regulatory requirements. The position leads program development and operations, manages work plans and day-to-day referrals, develops provider networks and training, oversees contracts and reporting, and coordinates with case management, IT, management, community stakeholders, and regulatory agencies. It identifies and resolves program issues and recommends operational improvements.

Requirements

Bachelor’s degree in healthcare, business, social work, or a related field, or equivalent experience, training, or coursework.
At least two years of experience in health, community-based social services, and/or a managed care setting with responsibility for program operations.
Program management experience.
Ability to assess training needs and methods, develop training materials, and conduct training using varied techniques appropriate to the audience.
Ability to direct and manage cross-functional, multi-departmental projects to completion with minimal supervision.
Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities.
Advanced working knowledge and proficiency with Microsoft Suite applications, and ability to operate applicable software.
Ability to use a keyboard with moderate speed and a high level of accuracy.
Excellent oral and written communication skills, including clear and concise communication with internal departments and outside entities by telephone, in person, and in writing.
Ability to facilitate meetings effectively and deliver information or presentations to management, regulators, and staff.
Ability to work effectively under pressure, prioritize accurately, and complete tasks within established timeframes.
Ability to take initiative and exercise good judgment when making decisions within the scope of the position.
Ability to maintain confidentiality and comply with SCFHP policies and procedures.
Ability to perform the job safely with respect to others, property, and individual safety.
Valid California driver’s license and acceptable driving record for travel to offsite meetings or events, or ability to use other transportation to attend them.
Ability to perform the essential functions with or without reasonable accommodation, including the listed mobility, lifting, visual, dexterity, hearing/talking, and reasoning requirements.

Nice To Haves

Experience with SQL development language and/or Tableau.

Responsibilities

Lead development and operations of the CHW benefit, including project framing, work-plan development and management, business case analysis, user testing, implementation, and outcome measurement.
Execute program work plans by engaging internal departments, vendors, providers, and consultants; convening and facilitating meetings; supporting and validating reporting data; and monitoring program activities and deadlines.
Manage workflows, assignments, turnaround times, and follow-up for day-to-day CHW referrals and assistance requests, responding promptly to members and internal or external entities.
Monitor workflows, programs, and projects for compliance with CMS, DHCS, DMHC, and NCQA regulations and guidelines.
Serve as a subject matter expert and SCFHP liaison with community stakeholders involved in the CHW network, workforce development, and benefit implementation.
Develop and deliver initial and ongoing training on CHW benefit eligibility and access for SCFHP staff, network providers, and delegates.
Develop, expand, and manage a contracted provider network, including recruitment, capacity management, and coordination with certification programs to ensure provider access.
Coordinate with case management and IT staff to ensure IT systems address CHW data needs for required reporting and program evaluation.
Support and oversee the development, approval, and monitoring of provider contracts.
Oversee CHW data analytics and timely, accurate completion and submission of CHW reports, coordinating with IT and other internal departments.
Monitor and collaborate with management on policies, procedures, and workflows that support compliant CHW integration and operations.
Identify, research, and resolve program issues; escalate critical issues, problems, and delays to management.
Provide management with regular updates on assignment, workflow, and training status and outcomes, and recommend operational improvements.
Oversee development, updating, and sharing of an inventory of relevant CHW providers and workforce capacity to support care coordination and population health management.
Participate in meetings and calls with regulatory agencies, NCQA, SCFHP management, delegates, and vendors to obtain and capture requirements and timelines.
Perform other related duties as required or assigned.