MANAGED CARE PROGRAM MANAGER

Description

The Managed Care Program Manager (MCPM) is responsible for managing various MSO projects from inception through completion, and the many sub-projects devised from the NEMS RBO (Risk Bearing Organization) operation, including but not limited to the NCQA accreditation and recertification project, State of CA’s CalAIM initiatives, CMS ACO REACH model program, health plans’ CAHPS program, Medicare Risk Adjustment program, etc. 

The MCPM is responsible for the end-to-end project management activities, including all design phases, client interaction, facilitate program implementation, develop project plans and timelines, monitor performance/track progress, report and communicate project findings, improvement activities and outcomes to key stake holder(s) for optimum performance results. 

This position requires high level of critical thinking skills and understanding of the managed care operational structures related to payment and reconciliation protocols and processes and a relevant degree of creativity and latitude.  The MCPM is expected to carry healthcare strategic, operational, and administrative knowledge and experience in supporting the NEMS RBO and ACO growth and accreditation efforts.

ESSENTIAL JOB FUNCTIONS:

• Perform the day-to-day management activities, including project management, problem resolution and other activities to assist in the facilitation of a successful implementation of Managed Care programs.
• Evaluating the scope of a project and identifying critical factors to ensure success completion.
• Responsible to initiate proposal writing and attend interviews for potential new projects.
• Developing detailed project plans, timelines with clear milestones and workflows to support the implementation of the project.
• Identifying key project resources and ensuring their adherence to the project plan by communicating work plans, workflows, and facilitating meetings to promote success project implementation.
• Collaborate with cross functional teams to ensure program objectives are achieved including assisting with the development of both long-term and short-term goals and procedures.
• Defining and reporting on key measures of success, monitoring performance tracking progress against targets/identified goals, communicate performance results to key stake holder(s) for improvement strategy.
• Responsible to document workflow activities and processes, and to develop feedback reports to communicate project findings and improvement activities to collaborators and other stake holder(s), both internal and external.
• Monitor performance across critical areas, identify and escalate areas of concern, and investigate/develop interventions to improve performance.
• Collaborate with cross functional teams to ensure compliance with regulatory, contractual, and accreditation requirements. Assist in developing and maintaining policies and procedures as required by regulatory and accreditation agencies.
• Participate in conferences, webinars, as well as internal/external meetings representing MSO as the subject matter expert for the varies managed care programs.
• Performs other job duties as required by manager/supervisor.

Qualifications

• A bachelor’s degree is required.
• Demonstrated proficiency in MS Power Point or Google Slides, including templates, animation, graphs, tables, and charts is required.
• 3-5 years of experience in health care setting with program/project management experience is strongly preferred.
• Experience in identifying healthcare inequity and implementing new health care projects and initiatives is strongly preferred.
• Experience in working with or familiarity with a Federally Qualified Health Center or a safety net clinic is strongly preferred.
• Ability to interpret data to systematically analyze problems, draw relevant conclusions, and devise an appropriate plan of action.
• Ability to work with minimal supervision to meet program/project requirements and deliverable.
• Ability to provide verbal and written program/project updates to other NEMS departments and external healthcare partners.
• Strong customer service orientation. Ability to establish and maintain productive business relationship, manages conflict, and negotiates solutions, ability to work with people from diverse backgrounds and experiences.
• Excellent verbal and written communication skills

LANGUAGE:

• Must be able to speak, read and write English fluently
• Ability to speak, read and write in another language is a plus

STATUS:

• This is an FLSA Exempt position.
• This is not an OSHA high-risk position.
• This is a Full Time position.
   

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
 

Salary : $103,761 - $118,284