Program Manager; Provider Relations

Overview

Program Manager (Provider Relations)

Cal Optima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join Cal Optima.

The Program Manager leads the development and implementation of special projects, programs and new initiatives for Provider Relations. The incumbent assists with implementations of programs with departmental and organizational-wide impact and interacts with all levels of staff, providers and external stakeholders. Responsible for all aspects of a project throughout its lifecycle including, but not limited to the scope, schedule, documentation, coordination, provider education and training, resources, quality, cost and change.

Project assignments may be within the Provider Relations or Network Operations department or may involve working at large in the organization and externally with providers and community stakeholders.

• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
• Develops and implements special projects, programs and new initiatives in a cross-functional capacity.
• Manages multiple small to medium sized projects under tight timelines simultaneously.
• Researches specific policy issues, regulatory/legislative mandates operational improvements, analyzes options, develops and presents recommendations, and documents decisions regarding the policy and financial implications of certain major initiatives for Provider Relations.
• Completes statement of work and work breakdown structure for projects and business plans for all lines of business.
• Participates in the department's fiscal year strategic planning process; evaluates and carries out departments' fiscal year strategic plan.
• Writes and makes recommendations to policies and procedures, and ensure knowledge of same, related to assigned projects and programs.
• Manages and coordinates the Cal Optima Provider Manual for all lines of business to ensure information is current with regulatory language and requirements.
• Provides analytical support and technical expertise on requests for information from management, and other staff regarding provider related issues and trends.
• Stays current on the local, state, and federal healthcare environment to identify public policy and market trends that may impact Cal Optima's provider programs and/or mission.
• Builds, maintains, and enhances relationships with key internal and external stakeholders.
• Ensures Provider Relations and Network Operations materials posted on the Cal Optima website are current.
• Presents processes and/or proposals as required.
• Other projects or duties as assigned.

• Work independently or in a team environment.
• Establish and maintain effective working relationships with Cal Optima leadership and staff.
• Communicate clearly and concisely, both verbally and in writing.
• Analyze and make recommendations regarding provider related issues.
• Evaluate data, manipulate spreadsheets, create reports and perform quantitative analysis.
• Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
• Work in a dynamic environment with both short-term and long-term deadlines.

• Bachelor's degree in a health-related field or related area; or equivalent work experience required.
• 3 years of experience working in a health plan or IPA/medical…