Program Manager III - Payer and Network Strategies

Cleveland Clinic

2d•Remote

About The Position

The Program Manager III manages the implementation and ongoing maintenance of designated programs, developing systems and procedures to support efficiency and effectiveness. The role oversees two to three state and federal value-based care contracts with Medicaid and Medicare and serves as a subject matter expert on contract performance and analytics. The manager analyzes performance data to identify gaps, collaborates with clinical teams on strategies to meet contractual metrics, and prepares presentations to communicate findings and progress. The position also serves as a liaison between the department and external communities, coaches and mentors staff, and participates in the budgetary process to support program goals. The position works days, 8:00 a.m. to 5:00 p.m. It is primarily remote, with Independence FHC as the primary on-site location for monthly visits. Additional visits to other facilities may be required based on business needs.

Requirements

Bachelor's degree in Business Administration, Healthcare Administration, or a related field and five years of related experience, or a master's degree and four years of experience.
Knowledge of statistical and financial analysis, primary research, and business plan development.
Strong presentation, communication, and training skills.
Value-based care experience.

Nice To Haves

Master’s degree.
Healthcare experience.
Experience handling health insurance contracts.
Business analytics experience.
Experience using Copilot, Tableau, and Power Automate.

Responsibilities

Develop, implement, manage, and maintain operational systems and activities.
Oversee two to three state and federal value-based care contracts with Medicaid and Medicare.
Serve as a subject matter expert on contract performance and analytics.
Analyze performance data to identify gaps and collaborate with clinical teams to develop strategies for meeting contractual metrics.
Prepare presentations to communicate findings and progress.
Serve as a liaison with all levels of the organization and outside the community.
Manage multiple priorities and projects with competing deadlines and allocate time to meet completion requirements.
Coach and mentor other positions in the department.
Review and monitor adherence to Human Resources policies and corporate compliance procedures.
Participate in the budgetary process to support program goals.
Perform other duties as assigned.