Program Manager Jobs

About The Position

Requirements

• Bachelor's degree in a related field, or equivalent work experience in Business, Health Care Management, or Nursing.
• At least 5 years of experience in direct program development, program management, and/or project management; healthcare experience is preferred.
• At least 3 years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, or PCMH.
• At least 2 years of experience designing, developing, and implementing STARS, CAHPS, HEDIS, and other enterprise quality-related programs across a variety of settings.
• Experience defining eligible populations, service mix, delivery system configuration, and financing for quality programs.
• Experience integrating behavioral, clinical, social, and community health care for members with multiple chronic conditions.
• Experience working with multiple market leaders to coordinate consistent quality initiatives.
• Experience conducting assessments, contractual reviews, and business plans for new quality improvement programs, including internally sourced or vendor-sourced programs, and/or integrating innovative approaches to improve company-wide quality ratings.
• Compliance with company policies and standards.

Nice To Haves

• Master's degree in a related field such as Business or Health Care Management (MBA, MHA, MPH, or MSN).
• Six Sigma certification.
• Lean certification.
• Certified Professional in Healthcare Quality (CPHQ).

Responsibilities

• Collaborate with Quality, Health Services, and Operations business owners and cross-functional work groups to develop and implement standards, policies, procedures, workflows, and decision support systems.
• Oversee programs supporting strategic initiatives involving Health Services and clinical and operational quality administration.
• Design and facilitate programs, systems, workflows, and integration efforts aligned with corporate, market, contractual, regulatory, and quality requirements.
• Serve as the content and technical subject matter expert for operational managers and directors on key project initiatives.
• Develop detailed work plans; facilitate root cause analysis; identify and socialize process enhancements; set deadlines; assign responsibilities; and monitor and summarize project progress.
• Lead state-required Performance Improvement Projects (PIPs), including topic selection, root cause analysis, implementation, and final submission.
• Conduct needs assessments and identify information needs to ensure program teams and external stakeholders receive timely information.
• Partner with Quality Analytics and Improvement Teams to determine data needs and assist in designing tools and reports.
• Provide consulting and analysis services to clinical and operations staff to support initiatives that improve patient quality of care.
• Perform other duties as assigned and comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401K plan
• Stock purchase plans
• Tuition reimbursement
• Paid time off
• Holidays
• Flexible approach to work, with remote, hybrid, field, or office work schedules
• Potential additional forms of incentives