Program Manager, Senior, Medi-Cal QI
About The Position
The Program Manager, Senior, Quality Improvement, supports the Medi-Cal Quality Improvement team in developing and executing targeted quality improvement initiatives to improve performance across quality rating systems, including HEDIS, MCAS, CAHPS, NCQA Health Plan Ratings, DMHC HEQMS, and Medicaid QRS. The role designs, develops, and manages quality interventions, toolkits, clinic days, and analytic insights for tertiary provider groups, with the goal of achieving measurable improvement in quality performance. The position partners with internal Quality Program Managers and cross-functional teams, clinical leaders, provider organizations, vendors, and community-based organizations to execute improvement strategies, strengthen provider relationships, and align QI programs with long-term organizational goals. It is a hybrid, field-based role serving the Los Angeles area. Work includes at least five to eight days per month at the Long Beach or Woodland Hills offices and/or local clinics; clinic visits typically occur one to two days per week. Some evening and Saturday hours may be required.
Requirements
- Bachelor’s degree, or a high school diploma/GED plus four years of additional relevant experience in lieu of a degree.
- At least five years of healthcare experience in Quality Improvement/Quality Management, including demonstrated experience with quality improvement, process improvement, and practice transformation techniques.
- At least three years of experience working with IPAs, medical groups, FQHCs, and/or providers serving the Medi-Cal population.
- Previous project or program management experience.
- Ability to work in a hybrid, field-based role serving the Los Angeles area, including at least five to eight days per month at the Long Beach or Woodland Hills offices and/or local clinics.
- Availability for some evening and Saturday hours, as required.
Nice To Haves
- Knowledge of HEDIS and accrediting body requirements, such as NCQA and DHCS.
- Proficiency with the Cozeva application.
- Experience with Tableau for quality reporting.
- Experience reviewing medical records to identify service compliance and missed opportunities.
- Experience in the California delegated model or with highly integrated clinical delivery systems.
Responsibilities
- Plan, execute, and evaluate large and complex program initiatives to improve quality performance in the Medi-Cal line of business.
- Develop and monitor measurement strategies for large change and improvement initiatives.
- Manage programs from initiation or pilot through delivery and spread, monitoring for continuous improvement.
- Influence the business unit, its strategies, and objectives as part of the broader QI team.
- Develop expertise in company quality initiatives and the products, functions, marketing, and service policies and procedures that support them.
- Serve as a quality expert to internal constituents and drive successful improvement initiatives in the Medi-Cal line of business.
- Lead and support interventions to improve performance on HEDIS, MCAS, CAHPS, NCQA Health Plan Ratings, DMHC HEQMS, and Medicaid QRS.
- Lead in-person community-based clinic days at Community Based Organizations in Los Angeles County, averaging two per month as scheduled.
- Educate and work with external partners and participating practices to identify innovation opportunities and adopt improvement actions.
- Partner with providers in person at clinic locations to identify practice barriers and areas for improvement.
- Use independent judgment to develop methods, techniques, and evaluation criteria for obtaining results.
- Assist with planning and directing budgets, as needed.
- May act as the business unit liaison to corporate initiatives and projects.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
