Program Manager, Sr. (Contracting Compliance)

Program Manager, Sr. (Contracting Compliance)

CalOptima

CalOptima Health is seeking a highly motivated an experienced Program Manager, Sr. (Contracting Compliance) to join our team. The Program Manager Sr of Contracting Compliance will lead the development, implementation and ongoing oversight of the Contracting department's regulatory compliance activities and reporting and be responsible for department policy and procedure updates. The incumbent will be responsible for the oversight of special projects and new initiatives, including items such as drafting, submitting and tracking of CalOptima Board Action Agenda Referrals (COBAR). The incumbent will interface with various levels of staff, other organization departments and external stakeholders. The incumbent will be responsible for all aspects of project lifecycles through implementation, including, but not limited to, the scope, schedule, documentation and reporting, coordination, staff education and training, resource development, quality controls, ongoing monitoring and oversight. The incumbent will be accountable to identify and report issues of compliance to the Director of Contracting and Manager of Contracting and will develop and recommend solutions and corrective actions to ensure the Contracting department complies with all internal and regulatory requirements. The incumbent will be the subject matter expert who will create, recommend and/or implement department policies and processes, including, but not limited to, developing necessary corrective actions plans identified by Compliance and/or the Director of Contracting, and may be asked to serve as the content and technical adviser to operations and various business owners.

Position Information:

• Department: Contracting
• Salary Grade: M - $85,000 - $141,086
• Work Arrangement: Partial Telework

  **This position is eligible for telework in California.**

Duties & Responsibilities:

• 85% - Program Support
  • Keeps current on the local, state and federal requirements and identifies issues that may impact department policies, processes, resources and tools.
  • Collaborates with the Regulatory Affairs and Compliance department to implement program requirements and update policies and procedures pursuant to obligations imposed by the Department of Health Care Services (DHCS) All Plan Letters and Regulatory Memos.
  • Researches and analyzes regulatory and legislative mandates and updates policies to ensure department compliance.
  • Collaborates with the Director of Contracting, Manager of Contracting and other department staff in drafting, coordination and submission of department COBARs.
  • Completes program project plans.
  • Coordinates with Provider Relations and other departments for the review of and update to the CalOptima Health Provider Manual for all lines of business, as applicable.
  • Coordinates internal discussions and resources to ensure operational decisions and needed deliverables are addressed timely and appropriately.
  • Identifies operational problems or issues, develops resolutions and ensures adherence to program work plans and short- and long-term objectives.
  • Develops and presents operational, programmatic or other presentations to management as needed.
  • Oversees, organizes and tracks numerous and diverse activities, timelines and issues.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Ensures compliance with program rules and requirements, as well as work plans and identified tasks. - (Essential)
• 10% - Administrative Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Acts as a liaison with internal CalOptima Health departments during regulatory or internal audits.
• 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

• Bachelor's degree in public health, business administration, business management or related field required.
• 4 years of experience working with health care delivery systems or in a public agency serving health care related populations required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

• Master's degree in public health, business administration, business management or related field.
• Project Management Professional (PMP) certificate.
• Direct project management experience.
• Experience working within contracting and/or provider relations.

Required Licensure / Certifications:

• N/A

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

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

Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.

IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is April 19, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.

Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

To apply, please visit: https://jobs.caloptima.org/jobs/program-manager-sr-contracting-compliance-505-city-parkway-california-united-states

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