Job Description

Your Role

The Commercial CMO Team provides clinical oversight for programs and processes that support members' health care, reduce costs, and improve quality. The Program Manager Clinical, Consultant reports to the Director of Program Management, Clinical - CMO.

In this role, you will analyze clinical and financial data to identify trends and opportunities to improve care and manage costs for employer-funded health insurance. Leading projects to address these opportunities and develop presentations that clearly communicate the clinical insights and recommended actions. You will also facilitate meetings with internal and external stakeholders and drive improvements in healthcare cost trends through both direct interventions and broader, system-level initiatives.

Responsibilities

Your Work

In this role, you will:

• Own and manage the intake process and queue for patient information summary requests, ensuring requests are prioritized, tracked, and completed in a self-directed manner.
• Collate clinical data accurately from multiple systems and sources, synthesizing relevant information into a cohesive clinical story for use in clinical rounds, stakeholder discussions, and related business needs.
• Prepare clinical summaries that may be presented directly or used by clinical leaders and cross-functional partners to support decision-making, care coordination, and issue resolution.
• Use multiple software systems and quickly build proficiency in new platforms, including Excel and PowerPoint, to support analysis, documentation, reporting, and presentation development.
• Maintain a strong focus on patient privacy, confidentiality, and appropriate handling of sensitive clinical information.
• Apply an understanding of client needs and business context to ensure clinical summaries are accurate, relevant, and appropriately tailored for the intended audience.
• Identify opportunities to support additional project, process improvement, or strategic work related to clinical findings, case summary trends, and themes emerging from clinical rounds.

Qualifications

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires current California LVN, RN, NP, or PA license
• Prefers familiarity with health care data and the health care delivery system in California; health plan or provider experience strongly desired
• Strong organizational and/or project management skills, consistent ability to "self-start" and take ownership of end-to-end taskforce activities
• Excellent written and oral communication skills, ability to facilitate cross-functional discussions, lead teams through influence to drive actions and outcomes
• Experience in cost of health care analysis, population health outcomes, and/or program evaluation desired

Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.