Program Manager, Senior, Medi-Cal QI
About The Position
The Program Manager, Senior, Quality Improvement designs, develops, and manages quality interventions, toolkits, clinic days, and analytic insights for tertiary provider groups to support measurable improvement in Medi-Cal quality performance. The role partners with internal Quality Program Managers, cross-functional teams, clinical leadership, provider organizations, external vendors, and community-based organizations to execute improvement strategies, strengthen provider relationships, and align QI programs with long-term organizational goals. It serves as a quality expert and supports interventions across quality rating systems including HEDIS, MCAS, CAHPS, NCQA Health Plan Ratings, DMHC HEQMS, and Medicaid QRS. This is a hybrid, field-based role serving the Los Angeles area. It requires 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. The role also leads in-person community-based clinic days in Los Angeles County, averaging two per month as scheduled. Some evening and Saturday hours may be required.
Requirements
- Bachelor’s degree, or a High School Diploma/GED and four years of additional relevant experience in lieu of a degree.
- At least five years of healthcare experience in Quality Improvement or 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 who serve the Medi-Cal population.
- Previous project or program management experience.
- Some evening and Saturday hours may be required.
Nice To Haves
- Knowledge of HEDIS and accrediting body requirements, such as NCQA and DHCS.
- Proficiency with the Cozeva application.
- Tableau experience 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, and monitor them for continuous improvement.
- Influence the business unit, 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 for internal constituents to drive successful Medi-Cal improvement initiatives.
- 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 in person with providers at clinic locations to identify practice barriers and areas for improvement.
- Exercise independent judgment in developing methods, techniques, and evaluation criteria for obtaining results.
- May assist in planning and directing budgets.
- 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
