Clinical Operations Program Manager--Operating Model

Job Summary The Clinical Operations Program Manager – Operating Model is responsible for programmatic design, including the management of workflows, and implementation and integration to the clinical platform in support of the clinical operating model. The Program Manager develops enhancements for clinical programs and the Clinical Operating Model for all products and lines of business in alignment to strategic objectives, regulatory requirements, quality standards, and contractual commitments upheld by the Clinical Operations organization. Essential Functions Responsible for successful delivery of clinical programs through development, build, implementation and integration of workflows and system design to support the clinical model, Market/ Product regulatory requirements and commitments, and quality standardsSupport the development and management of clinical programs including data analysis to support the design, project plan development, workflow design, system design, program tracking and implementation Support continuous improvement of program management through Plan-Do-Study-Act (PDSA) review to enhance processes and toolsResponsible for monitoring and tracking model impact requests, workflow, product and program performanceCollaborate with Training and Auditing teams on the development of new program materials, system workflows, assessments, system design and updates to existing training and auditing to align to operational changes and enhancementsCollaborate with Clinical Operations Clinical Systems Configuration teams to ensure alignment and prioritization of program design with system build and reporting capabilities Support new business activities including developing responses to Request for Proposals (RFPs) and new business implementation activities as needed related to the design and operations of the clinical modelCollaborate with Informatics, Analytics, and Reporting teams to ensure alignment of process changes to metrics and reporting standards and definitionsWork closely with business executives, stakeholders, and leaders from all markets and products to ensure programs, developments, enhancement and integration in the clinical platform align with business strategy, regulatory requirements, and are properly resourced, and managedProvide regular reporting and maintain ongoing communications to senior management, stakeholders, and executive sponsorsRepresent the clinical operating model interest in the intake process, governance and prioritization of intakes and enhancement requestsAccountable for routine monitoring of outcomes to identify opportunities for improvement in program design and application.Perform any other job duties as requested Education And Experience Bachelor’s Degree in nursing, engineering, business management or related field or equivalent years of relevant experience is requiredMaster’s Degree in related field is preferredMinimum of five (5) years of healthcare experience is requiredMinimum of two (2) years of product or program management experience is required Competencies, Knowledge And Skills Excellent proficiency with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc.Demonstrates excellent analysis and reporting skillsDemonstrate skills related to system design, program and project/process managementSkilled in interpretation of analytics and insightsExcellent decision making/problem solving skillsExceptional interpersonal and relationship building skillsExcellent critical listening and thinking skillsProven ability to effectively interact with all levels of the organization of management within and externally to the organizationExcellent written and verbal communication skillsCustomer service orientedAbility to shape the approach to needed results and gain consensus of the approachProven ability to prioritize work and team assignments to deliver projects on time, on budget, and meeting stakeholders’ expectationsKnowledge of Utilization Management (UM), Case/Care Management (CM) and Behavioral Health (BH) healthcare domain is required.Strong experience in the healthcare payer industry and knowledge of Medicaid and MedicareAbility to understand and implement regulatory and contractual requirementsAbility to analyze processes across multiple functional areasAbility to work independently and within a team environmentAbility to review and implement evidence based trendsAbility to develop, prioritize and accomplish goals Licensure And Certification Project Management Professional (PMP) or equivalent certification/training is preferred; Program Management Certification (PgMP) is preferredRegistered Nurse (RN) or other clinical licensure is preferredCCM preferred Working Conditions General office environment; may be required to sit or stand for extended periods of timeHigh potential for remote work $113,000.00 - $197,700.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.