Clinical Operations Program Manager – Operating Model

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Clinical Operations

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Design, develop, build, implement, and integrate clinical program workflows and system designs • Develop and manage clinical programs through data analysis, project planning, workflow design, system design, tracking, and implementation • Support continuous improvement through Plan-Do-Study-Act (PDSA) reviews • Monitor and track model impact requests, workflows, product performance, and program performance • Collaborate with Training and Auditing teams on program materials, system workflows, assessments, system design, and updates • Collaborate with Clinical Operations Clinical Systems Configuration teams on program design, system build, and reporting capabilities • Support new business activities, including RFP responses and clinical model implementation • Collaborate with Informatics, Analytics, and Reporting teams to align process changes with metrics and reporting standards • Work with executives, stakeholders, and leaders across markets and products to align programs with strategy, regulatory requirements, and resourcing • Provide regular reporting and ongoing communications to senior management, stakeholders, and executive sponsors • Represent the clinical operating model in intake, governance, and prioritization processes • Monitor outcomes to identify opportunities for improvement in program design and application • Perform other duties as requested

🎯 Requirements

• Bachelor’s Degree in nursing, engineering, business management or related field or equivalent years of relevant experience is required • Minimum of five (5) years of healthcare experience is required • Minimum of two (2) years of product or program management experience is required • Excellent proficiency with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc. • Excellent analysis and reporting skills • Skills related to system design, program and project/process management • Skilled in interpretation of analytics and insights • 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 • Master’s Degree in related field is preferred • 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

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • High potential for remote work