Job Title

Program Manager (Quality Incentives)CalOptimaJoin Us in this Amazing OpportunityThe Team You'll JoinWe are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.More About the OpportunityWe are hoping you will join us as aProgram Manager (Quality Incentives)and help shape the future of healthcare where you'll be an integral part of ourQuality Analyticsteam, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Under the general direction of the Director of Quality Initiatives, You will collaborate and coordinate with leadership to design, implement and evaluate quality incentive programs. You will support with leading, implementing and optimizing pay for value incentive programs across our provider and hospital network. You will interact with CalOptima Health's executives and management, legal counsel and state and federal regulatory agencies. Additionally, you will support CalOptima Health staff on related projects as needed. Together, we are building a stronger, more equitable health system.Your Contributions To the Team: 80% ‐ Program ManagementLeads end‐to‐end management of provider incentive programs, health network pay‐for‐value initiatives and hospital quality pay for value models. Collaborates with cross‐functional teams and vendors to develop program strategies and performance metrics. Monitors quality incentive program performance, identifies improvement opportunities and implements data‐driven enhancements. Communicates program goals, progress and outcomes to internal stakeholders and external partners. Participates in meetings with providers, health networks and hospital partners to review performance for quality measures and CalOptima Health's pay for value (P4V) programs. Assists partners with understanding and implementing best practices to improve performance. Assists in the implementation of quality improvement grant programs that utilize unearned incentive dollars. Assists management in the development of specifications and scope of work for a Request for Proposal (RFP), Request for Quote (RFQ) or Request for Inquiry (RFI) to support new program development as needed. Supports program design, development and implementation of quality programs impacting, but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), Managed Care Accountability Sets (MCAS) and Centers for Medicare & Medicaid Services (CMS) STARs quality measures consistent with the quality program and workplan. Produces slide decks, summaries, root cause analyses, impact analyses and other reports as needed by leadership. Applies analytical skills to evaluate data based on project specifications; requests and interprets data to support decision‐making and communicates insights to cross‐functional stakeholders. Establishes key performance indicators (KPIs) and metrics to monitor project progress and performance, providing regular updates to senior management. Leads performance and quality improvement projects, Plan Do Study Act or other formats as needed. Reviews evidence‐based literature for best practices to incorporate into strategy. Develops and oversees the process of written tools for programmatic use, including program plans, surveys and evaluation instruments. Maintains current knowledge of applicable regulations or clinical guidelines related to program development. Stays current on the local, state and federal health care environment and identifies issues that may impact CalOptima Health's quality program and work plan.15% ‐ Administration SupportParticipates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department. Reviews and assists in updating policies and procedures to ensure knowledge related to assigned programs and projects is kept up to date. Works with all CalOptima Health departments in response to inquiries, problem‐solving and promoting CalOptima Health's mission and message.5% ‐Completes other projects and duties as assigned.Do You Have What the Role Requires? Bachelor's degree in healthcare or a related field required PLUS 3 years of experience in program development, program/project management or quality metrics analysis and improvement 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.You'll Stand Out More If You Possess the Following: Master's degree in public health, health administration or related field.1 year of experience working in a highly matrixed, mission‐driven organization.What the Regulatory Agencies Need You to Possess? N/AYour Knowledge & Abilities to Bring to this Role: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.Your 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, kn