Program Manager - Utilization Management, South San Francisco, CA
PROGRAM MANAGER-UTILIZATION MANAGEMENT
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Program Manager that will oversee the following: Clinical program development, integration and execution in support of departmental processes, operations and administrative efficiency for the Health Services Department which may include: Pharmacy Services, Quality Improvement, Utilization Management and Care Coordination. The incumbent has primary accountability for developing and managing clinical programs within the organizational framework. The Program Manager will deliver results-oriented solutions that enhance program operations, and improve the overall quality and cost effectiveness of the services delivered by the Health Plan.
The essential duties & responsibilities will include the following:
- Manage program(s) from initiation through delivery and monitor for continuous improvement.
- Provide input into designing strategies for alignment with functional unit goals and objectives.
- Develop methods, techniques and evaluation criterion for obtaining results.
- Plan, execute and evaluate program initiatives to improve performance.
- Participate cross-functionally in business planning to support business unit strategy.
- Contribute to project teams, assigning and monitoring work of team members and providing guidance and leadership.
- May act as the business unit liaison to corporate initiatives and projects.
- Educate and work with external partners and participating
- Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows.
Education and Experience: Bachelor’s Degree in Business Administration, Health Care Management or Public Policy required. MBA, MPH or MPP preferred, Minimum three (3) years of managed care experience preferably with Medicare/Medi-Cal experience, Experience with quality improvement/process improvement techniques required, Previous project/program management experience required.
Knowledge of: Quantitative reasoning (financial analysis, return on investment analysis, statistics, utilization metrics), Healthcare Policy (different delivery systems, payment models, and Government Programs), Raw Data and Analytic capabilities, Relationship Building and Interpersonal Skills, Financial/Quantitative Acumen, Change management, process improvement and redesign, Organizational behavior skills with a focus on driving for results, Project management, program evaluation and consulting skills, Knowledge of accrediting/regulatory body requirements, Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
Ability to: Confidently present to large groups, Work cooperatively with others, Work as part of a team and support team decisions, Communicate effectively, both verbally and in writing, Adapt to changes in requirements/priorities for daily and specialized tasks, Think critically and make informed decisions.
Starting Compensation Range: depending on experience.
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: email@example.com or via fax: (650) 616-8039. File by: Continuous until filled. EOE. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.