Job DescriptionYour Role The Care Management team is looking for a strategic leader with Care Management experience who can help support our Population Health Management (PHM) Medi-Cal Care Management line of business. The Program Manager Clinical, Senior will report to the Director of Care Management. In this role you will monitor and drive initiatives for the Transitional Care Services (TCS) program that will improve care transitions, reduce avoidable readmissions, enhance post discharge follow ups, and ensure compliance with regulatory requirements. You will serve as liaison between TCS, contracted provider organizations, hospitals, and internal stakeholders to optimize workflows, strengthen partnerships, and advance an integrated, whole health care model.
ResponsibilitiesYour Work In this role, you will:
- Direct small-scale, complex programs/projects that may involve multiple internal and external stakeholders
- Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
- Develop the program, integrated program plan, resource plan, contingency plan, and related project management artifacts
- Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
- Lead continuous workflow optimization to improve efficiency, quality, and member outcomes.
- Support operational integration and optimization of Community Health Advocate (CHA) workflows to improve care coordination and member engagement.
- Serve as the point of contact for Independent Physician Associations (IPAs) and hospitals for TCS-related operational inquires.
- Represent TCS during Joint Operations Meetings, provider workgroups, hospital meetings, and cross-functional committees.
- Conduct routine audits of TCS cases to ensure compliance with regulatory requirements, documentation standards, and clinical workflows.
- Identify trends, gaps, and operational risks through case reviews and performance monitoring.
- Other duties, as assigned
QualificationsYour Knowledge and Experience - Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree and completion of an accredited educational program that meets the requirements for the applicable professional license is required
- Clinical license within the state of CA required (RN, LVN, NP, PA, LCSW etc )
- 5 or more years of relevant experience in managed care, population health, care management, transitional care services, or healthcare operations required.
- 3 or more years of program management, project management, or operational leadership experience preferred.
- Experience working collaboratively with hospitals, IPAs, physician groups, and multidisciplinary team preferred.
- Knowledge of DHCS, CMS, NCQA, and Medi-Cal managed care requirements preferred.
Hybrid Virtual WorkThis role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
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.
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