Program Manager III, Risk Adjustment and Health Plan Surveys

Organization:

Sutter Health Plan - Valley

Position Overview:

As a program management expert, the incumbent will develop, manage, and execute regulatory and accreditation Quality programs of varying complexity. Effectively manage programs by setting clear milestones, expectations, and deliverables, clearly communicating goals, objectives, and responsibilities. Manages day-to-day operations of assigned programs, ensuring programs deliver high-quality and compliant results. Serves as liaison to internal and external customers, health plan partners, and vendors to collaborate and promote program goals and objectives. Coordinates with internal departments on analytics and data submissions to state and federal agencies, such as the Department of Managed Health Care and Centers for Medicare and Medicaid Services. Develop and implement policies, standard work, processes, and workflows to ensure effective and efficient operations and compliance with applicable standards, laws, and regulations. Oversees and coordinates the preparation of internal and external reports through gathering, analyzing, and summarizing program effectiveness data and information. Share these results with the vendor and relevant key stakeholders regularly. Identify areas in need of improvement and work with stakeholders to propose solutions. Oversee vendor and health plan partner activity and compliance with regulatory and accreditation standards. Supports Legal, Finance, Compliance, and relevant business areas to ensure smooth oversight of processes. Acts as the primary point of contact for vendors and issue resolution, with escalation to leadership as necessary. Serves as liaison to internal and external customers, health plan partners, and vendors to collaborate and promote program goals and objectives.

Job Description:

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

• Bachelor's: Business Administration, Healthcare Management or related field

TYPICAL EXPERIENCE:

• 5 years of recent relevant experience.

SKILLS AND KNOWLEDGE:

• Experience with program management in a healthcare or health plan setting.
• Knowledge of risk adjustment program management.
• Knowledge of health plan regulatory and accreditation surveys (e.g., Provider Satisfaction, After-Hours, Enrollee Experience, CAHPS).
• Lean, Process Improvement and/or Project Management experience.
• Advanced proficiency in MS Excel (Pivot Tables, Advanced Formulas).
• Development experience in Data Visualization Platforms (i.e. Tableau, Power BI) is a plus.
• Data-oriented, analytical, and detail-oriented with a passion for solving problems and understanding business processes.
• Effective cross-functional collaborator with the ability to effectively partner with teams through complex business situations to achieve program objectives.
• Organizational skills and the proven ability to manage multiple tasks and deadlines simultaneously.
• Superior oral and written communication skills with an innate attention to detail.
• Motivated and resourceful self-starter with the ability to anticipate needs, meet deadlines, and solve problems creatively, both independently and in team settings.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $48.72 to $73.08 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.

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