Program Manager, Senior - Medicaid & Medi-Cal

About the role

The Program Manager, Senior, Quality Improvement is responsible for the development and execution of targeted, quality improvement initiatives in support of the Medi-Cal line of business, contributing to improved performance on various quality rating systems including, but not limited to, Healthcare Effectiveness Data Information Set (HEDIS), Managed Care Accountability Set (MCAS), Consumer Assessment of Healthcare Providers and Systems System (CAHPS), National Committee for Quality Assurance (NCQA) Health Plan Ratings, Department of Managed Health Care (DMHC) Health Equity Quality Measure Set (HEQMS), and Medicaid Quality Rating System (QRS).

Responsibilities

• Responsible for planning, execution, and evaluation of large and complex program initiatives to improve quality performance in the Medi-Cal line of business.
• Develops and monitors measurement strategies for large change and improvement initiatives.
• Manages program(s) from initiation/pilot phase through delivery/spread and monitors for continuous improvement.
• As part of a broader QI team, influences the business unit, strategies, and objectives.
• Becomes an expert in company quality initiatives, as well as the products, functions, marketing, and/or service policies and procedures that support those initiatives.
• Serves as a quality expert with internal constituents to drive successful improvement initiatives in the Medi-Cal line of business.
• Leads and supports interventions to improve performance on HEDIS, MCAS, CAHPS, NCQA Health Plan Ratings, DMHC HEQMS, and Medicaid QRS.
• Leads in-person community-based clinic days at Community Based Organizations in San Diego County (3-6 days a month or as scheduled).
• Educates and works with external partners and participating practices as needed to identify innovation opportunities and adopt improvement actions.
• Partners with providers, in-person, at clinic locations to identify practice barriers and areas for improvement.
• Exercises independent judgment in developing methods, techniques, and evaluation criteria for obtaining results.
• May assist in the planning and direction of budgets.
• May act as the business unit liaison to corporate initiatives and projects.

Qualifications

• Requires a college degree or equivalent experience.
• Requires a minimum of 5 years of prior relevant experience.
• Requires at least 5 years of healthcare experience in Quality Improvement and Quality Management with knowledge in these specific areas: quality improvement, process improvement, practice transformation techniques.
• At least 5 Years of Medicaid/Medi-Cal experience required.
• 3 years working with IPAs, medical groups, FQHCs, and/or providers required.
• Previous project/program management experience required.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.