Program Manager, Medicare Insights and Operations

We are a mission-driven, community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person.

About the role

As Program Manager, Medicare Insights and Operations, you will be an integral part of our Operations Management team, helping to shape the future of healthcare. This position is approved for partial telework: if approved, you must work within the State of California and report to the main office in Orange, CA at least two days per week.

The role focuses on program design, development, implementation, and support of department initiatives for the Medicare line of business. You will deliver high-impact analytics and insights that drive informed decision-making, lead analytical initiatives from start to finish, and manage projects to ensure solutions are delivered on time and aligned with business priorities. You will collaborate with all levels of CalOptima Health’s staff and stakeholders.

Responsibilities

• Analytics & Insights (50%)
  • Participate in a mission-driven culture focused on high-quality performance, member service, consistency, dignity, and accountability.
  • Assist the team in carrying out department responsibilities and collaborate on short- and long-term goals.
  • Extract, structure, and analyze operational data across the Medicare Advantage business to answer leadership questions and surface trends, risks, and opportunities.
  • Build and maintain recurring dashboards, scorecards, and performance views.
  • Partner with subject matter experts to review data sources, evaluate new initiatives, develop summary reports, and formulate recommendations for leadership.
  • Produce ad hoc analyses to support decisions on retention, growth, member experience, and regulatory performance.
  • Track and monitor multiple concurrent initiatives to ensure project parameters and targets are met.
  • Translate unclear business questions into clear analyses and present findings in plain language for non-technical stakeholders.
• Programs & Initiatives (45%)
  • Lead program development and implementation, providing oversight for various programs and project plans for the Medicare line of business.
  • Own end-to-end operational initiatives, including scope, plan, timeline, stakeholders, and follow-through.
  • Operate cross-functional work teams and collaborate to translate analytic insights into impactful improvements.
  • Support process-improvement efforts, documenting current-state workflows and collaborating on future-state design.
  • Prioritize and manage multiple workstreams independently under tight deadlines.
• Other (5%)
  • Complete other projects and duties as assigned.

Requirements

• Bachelor’s degree in a related field plus 3 years of experience in operations, data analytics, project management, and/or program management, preferably in Medi-Cal Managed Care, Medicare, a managed care setting, health care, or a related area. An equivalent combination of education and experience may also qualify.
• Develop rapport and maintain effective working relationships with leadership, staff, and external contacts at all levels and diverse backgrounds.
• Work independently, exercise sound judgment, and communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including availability for evening and weekend events.
• Organize, analyze, problem-solve, and manage projects in a fast-paced environment.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Qualifications

• 5 years of experience in Medi-Cal Managed Care, Medicare, a managed care setting, health care, or a related area.
• Proficiency in database management (e.g., SQL, Power BI, Tableau).

Physical Requirements

• Ability to visually read information from computer screens, forms, and other printed materials.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication via telephone and face-to-face interactions.
• Manual dexterity for typing, writing, standing, reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment weighing 10 to 25 pounds.

Benefits

• Competitive compensation: Pay Grade 311 – $77,863 - $124,581 ($37.43 - $59.89/hour), based on education, experience, skills, and internal equity.
• Comprehensive benefits package and CalPERS pension program.
• Generous PTO program and flexible scheduling.
• Wellness programs, tuition reimbursement, and professional development opportunities.
• Career development opportunities and a quality work-life balance.

Schedule

This position is approved for partial telework, requiring work within the State of California and in-office attendance at the main office in Orange, CA at least two days per week.

Work Environment

Work is typically indoors and sedentary, subject to schedule changes and variable work hours, with occasional travel. The noise level is usually moderate. If located at PACE, work may involve a clinical setting serving the frail and elderly, with potential exposure to harmful or hazardous conditions and moderate to loud noise levels. Community-based roles may involve occasional outdoor work in varied temperatures and similar environmental conditions.