Program Manager, Provider Data Operations

About the role

The Program Manager, Provider Data Operations plays a crucial role in shaping the future of healthcare at CalOptima. Reporting to leadership, this position focuses on planning, designing, and implementing programs and initiatives that impact the Provider Data Operations department. Key responsibilities include reviewing and analyzing regulatory and operational requirements, developing frameworks for execution, and ensuring alignment with the organization’s strategy.

Responsibilities

• Collaborates with leadership to plan, design, and implement programs and initiatives impacting the Provider Data Operations department.
• Analyzes regulatory and operational requirements and oversees full-cycle implementation.
• Develops a framework for execution, ensuring programs align with the organization's strategy and meet departmental needs.
• Works with the Regulatory Affairs and Compliance department to analyze, track, and implement regulatory requirements.
• Conducts data quality checks, validates processes against requirements, and identifies risks, gaps, and resolutions.
• Supports management and leadership by analyzing strategic options and providing data-driven recommendations.
• Stays informed about local, state, and federal health care environments to identify public policy and market trends.

Requirements

• Bachelor's degree plus 3 years of experience in operations, data, project management, or program management, preferably in the health care industry.
• Master's degree preferred.
• Experience with managed care regulatory requirements.

Qualifications

• Develops rapport and establishes effective working relationships with CalOptima Health's leadership and staff.
• Communicates clearly and concisely, both orally and in writing.
• Manages multiple projects and identifies opportunities for collaboration.
• Motivates and leads multi-program teams and external committees/coalitions.
• Utilizes computer and appropriate software (e.g., Microsoft Office) and job-specific applications/systems.

Skills

• Excellent communication skills.
• Project management skills.
• Ability to manage multiple projects and collaborate effectively.
• Strong analytical and problem-solving abilities.
• Knowledge of managed care regulatory requirements.

Benefits

CalOptima Health offers a comprehensive benefits package including a CalPERS pension program, tuition reimbursement, professional development opportunities, and various wellness programs. The position is approved for partial telework within the State of California, and the final salary is determined based on experience and internal equity.

Pay

The pay grade for this role ranges from $77,863 to $124,581 annually, with a starting salary based on qualifications and internal equity.

Schedule

This position is approved for partial telework within the State of California. Employees may be required to come into the main office in Orange, CA, at least two days per week.