Program Manager - Managed Care (Hybrid)

Job Description

The Program Manager is responsible for supporting all facets of the program initiative, under the supervision of the department management. Responsibilities entail managing all aspects of educational programming including tactical initiatives, organizational updates and communication, and performance measurement. Focus will be on the creation and launch of new interventions, engaging with all relevant individuals and departments within Cedars-Sinai Medical Center, the Cedars-Sinai Medical Network, Marina del Rey Hospital, and other Cedars-Sinai Health System entities and affiliates, as appropriate, updating internal documents, and liaising with relevant external entities.

Job Duties & Responsibilities :

• Manages the full scope of the implementation of assigned projects throughout the project life cycle using accepted project management principles.
• Assists in defining, developing and implementing plans for improving efficiency and effectiveness.
• Participates in the best standard methodology development, testing and training as needed.
• Conducts meetings with staff, other departments and key collaborators to ensure consensus for the project.
• Assumes overall responsibility for assigned projects.
• Ensures smooth transition from project and solution definition to project delivery.
• Analyzes business flows and recommends change.
• Assumes ownership of customer relationships and follows issues through to closure.
• Manages documents for implementation, project schedule, weekly status reports.
• Completes focused reviews and special reports as requested.
• Collaborates with the healthcare team to implement strategies to resolve system issues.
• Serves as the liaison and point of contact supporting all business needs addressing operational concerns (both internal and external) comprising of key subject matters.
• Facilitates high standard collaborations between the client and other organizational departments or colleagues to ensure operational efficiency, improvement and satisfaction. This may include the preparation, distribution, and coordination of any follow-up subjects as the need arises to ensure efficiency.
• Coordinates and conducts routine client check-ins, addresses areas of dissatisfaction, areas of opportunity and / or process improvement and often facilitates ongoing touch bases as required.
• Monitors and tracks HMO enrollment by payor, line of business and physician for trends and anomalies. Works with Utilization Management and Medical Directors to ensure an adequate panel of contracted providers to service the network's membership.
• Monitors and Tracks all other aspects of Managed Care, quality & efficiency measures, Star ratings, access, physician network integrity, physician network performance, patient and provider experience, and utilization management the best standard processes (specialty cost).
• Develops and generates appropriate reports on size, magnitude, cost efficiency and comparative marketability of all networks for internal and external clients. Ensures physicians compensation adequacy and timeliness. Conduct market analysis to ensure alignment with budgeted benchmarks.
• Interact with internal and external providers, health plans, hospitals and regulatory agencies to resolve Network Operational issues to ensure compliance requirements are being met
• Ensure timely preparation of HMO budgets, reporting and network surveys.
• Manages and takes ownership for the full scope of the implementation of assigned projects throughout the project life cycle using accepted project management principles. This includes the coordinating and detailing the best standard methodologies, expectation, process changes and end user or client acceptance.
• Well versed within the various components that comprise Managed Care and its key concepts including but not limited to eligibility, enrollment, claims, contracting, compliance and financial performance.
• Knowledge and understanding of different reimbursement methodologies such as fee-for-service, capitation, case rates, ASA etc. and provide a comprehensive written documentation of that reimbursement methodology within a contract.
• Familiarity with regulatory standards including but not limited to : NCQA, ICE, DMHC, DHCS, CMS and contracted health plans.

Qualifications

Education :

Bachelor's degree in Business or health care related field required. Master's degree preferred.

License / Certification :

Project Management Professional (PMP) highly preferred.

Experience :

Three (3) years of Healthcare administration or project / program management required.

About Us

Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.

About the Team

With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinais medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.

Req ID : 5668

Working Title : Program Manager - Managed Care (Hybrid)

Department : MNS Managed Care

Business Entity : Cedars-Sinai Medical Center

Job Category : Administrative

Job Specialty : Administrative

Overtime Status : EXEMPT

Primary Shift : Day

Shift Duration : 8 hour

Base Pay : $41.33 - $64.06

Required

Preferred

Job Industries

Salary : $41 - $64