Note: The job is a remote job and is open to candidates in USA. Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. The Program Manager III, Clinical Operations will partner with Clinical Services leadership to design and lead care management programs, ensuring operational efficiency and compliance with regulatory standards.

Responsibilities

• Develop and foster relationships with senior Care Management leadership through ongoing collaboration on process improvement initiatives related to operational efficiency, workflow management, and analytical support
• Oversee departmental projects, including identifying initiatives, developing project plans and timelines, and managing project work through completion
• Lead interdepartmental meetings, serving as a subject matter expert and educator to promote cross functional understanding of Care Management workflows and processes
• As needed, oversee and conduct regular internal audits of clinical staff performance, evaluating adherence to Care Management standards, regulatory requirements, and organizational policies, and provide feedback on performance gaps to staff leadership
• Ensure Care Management training meets all standards set forth by the National Committee for Quality Assurance, Healthcare Authority, Centers for Medicare and Medicaid Services, and other applicable regulatory bodies
• Collaborate with leadership to develop and implement new programs and enhance existing programs, including participation in and leadership of division-level initiatives in addition to Care Management-specific activities
• Participate in internal cross functional teams to ensure care management programs meet regulatory and compliance requirements
• Serve as a resource and support for more junior Program Managers, delegating responsibilities as appropriate to help broaden team skillsets and balance work efforts within the department
• Serve as a liaison between data analytics staff and Care Management leadership to develop or modify care management reports used to assess productivity and program outcomes
• Produce care management reports and present findings to applicable leadership and or committees
• Identify opportunities to standardize and improve care management processes and partner with leadership and staff to implement efficient desk procedures across lines of business
• Perform other duties as assigned. Essential functions listed are not exhaustive and may be revised by the employer at its discretion

Skills

• Have a bachelor's degree or an equivalent combination of education and highly relevant experience
• Have a minimum of five (5) years of experience in program management administration, including developing and/or implementing programs or leading teams that develop and implement programs in a healthcare setting
• Have at least three (3) years of experience in care management operations in a program management and or process improvement role, and one (1) or more years of mentoring, training, or teaching experience
• Possess current, unrestricted licensure in the State of Washington as a Registered Nurse or as a Licensed Independent Clinical Social Worker
• Have experience using Microsoft Office products, care management workflows, software applications, and reporting tools
• Complete and successfully pass a criminal background check
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation

Benefits

• 10% annual incentive target based on company, department, and individual performance goals
• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year.
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

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