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 standards

Support 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 tools

Responsible for monitoring and tracking model impact requests, workflow, product and program performance

Collaborate 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 enhancements

Collaborate 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 model

Collaborate with Informatics, Analytics, and Reporting teams to ensure alignment of process changes to metrics and reporting standards and definitions

Work 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 managed

Provide regular reporting and maintain ongoing communications to senior management, stakeholders, and executive sponsors

Represent the clinical operating model interest in the intake process, governance and prioritization of intakes and enhancement requests

Accountable 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 required
• Master’s Degree in related field is preferred
• Minimum of five (5) years of healthcare experience is required
• Minimum 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 skills
• Demonstrate skills related to system design, program and project/process management
• Skilled in interpretation of analytics and insights
• Excellent decision making/problem solving skills
• Exceptional interpersonal and relationship building skills
• Excellent critical listening and thinking skills
• Proven ability to effectively interact with all levels of the organization of management within and externally to the organization
• Excellent written and verbal communication skills
• Customer service oriented
• Ability to shape the approach to needed results and gain consensus of the approach
• Proven ability to prioritize work and team assignments to deliver projects on time, on budget, and meeting stakeholders’ expectations

Knowledge 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 Medicare
• Ability to understand and implement regulatory and contractual requirements
• Ability to analyze processes across multiple functional areas
• Ability to work independently and within a team environment
• Ability to review and implement evidence based trends
• Ability to develop, prioritize and accomplish goals

Licensure and Certification:

Project Management Professional (PMP) or equivalent certification/training is preferred; Program Management Certification (PgMP) is preferred

Registered Nurse (RN) or other clinical licensure is preferred

CCM preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

High potential for remote work