Salary Range: $102,183.00 (Min.) - $124,877.00 (Mid.) - $163,492.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
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Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.Job Summary
Under the general direction of the Director of Utilization Management (UM) the Utilization Management Program Manager II is responsible for leading and managing a portfolio of strategic and transformational UM programs and projects that are generally complex and large in scope. The Program Manager II will synchronize the work of cross-functional project teams. A key function of this position is to serve as the primary point of contact between executive leadership and the program team, engage all stakeholders and communicate the program’s progress. The Program Manager II is accountable for working with and facilitating processes to accomplish complex program objectives, managing change and resolving issues that span project teams and departments by planning, organizing, directing and supervising program activities in a cost effective and productive manner to achieve strategic value as it relates to Utilization Management Policies and Procedures.
This position supports the development and implementation of Utilization Management initiatives to comply with regulatory and accreditation requirements such as those stated in contracts, CalAIM Population Health Management (PHM) Policy Guide, National Committee on Quality Assurance (NCQA) PHM, Department of Health Care Services (DHCS) All Plan Letters (APLs), and Centers for Medicare and Medicaid Services (CMS) Model of Care (MOC). In addition, this position ensures executive summaries of new policies and regulatory requirements are submitted to leadership for review and approval in a timely manner. Integral to the success of this position is positive interaction with business owners and unit staff, management, cross-functional team members and other department resources to ensure effective management.
Duties
Project Planning & Implementation: Guide program and project staff to develop project work plans that define the project purpose, scope, key milestones and tasks necessary to guide the project’s implementation, including complex projects (e.g. multi-stakeholder or multi-year projects); Monitor work plan updates to capture any changes that arise throughout the project implementation phase and manage progress and performance of project portfolio to track timely project execution; Steer and drive project direction to address and mitigate any anticipated project delays. Supervises multiple projects within UM to achieve continuous alignment with the organization’s strategic plans and objectives.
Program Development: Independently lead the design, development and building of program solutions using the ISEIO framework to address UM and managed care operational challenges that require collaboration with multiple external stakeholder senior management leaders. Expected to serve as a strategic thought partner with director and senior management leadership team members to advise on strategic programmatic options.
Accountability: Independently own and responsible for successful development, planning, and execution of projects, from initial concept to implementation stage, with minimal guidance and supervision from manager.
Stakeholder Engagement: Responsible for independently performing stakeholder mapping and identification of critical internal and external business (senior management) partners to jointly problem-solve complex member and provider issues. Facilitate constructive dialogue among internal and external stakeholders to ensure problems are properly assessed, analyzed and resolved. Manage political situations that arise when negotiating differences.
Relationship Building: Initiate and cultivate new relationships with external safety net stakeholders, using political judgment, in order to build strong external partner support needed to facilitate completion of strategic and operational initiatives.
Collaborates with leadership, management and other stakeholders including Business Owner(s), Investment Review Board, intake and program/project teams and participate in program governance and administration meetings as appropriate.
Position ensures executive summaries are submitted to the Investment Review Board/Leadership Team for review and approval in a timely manner. Upon Leadership approval, this position will manage the creation of definitive project execution plans (Plan of Record)
Active participation in internal & external initiatives
Perform other duties as assigned.
Duties Continued
Education Required
Education Preferred
Experience
Required:
At least 5-7 years of progressive work experience in health care or a related field, doing problem-solving, policy, and/or project implementation. At least 2 years of experience leading project teams. At least 2 years of experience of working within a managed care organization. Experience building relationships with organizations and business partners.
Preferred:
Experience facilitating complex decision making among multiple executive stakeholders with different interests and priorities. Experienced in vendor/contract management and negotiations.
Skills
Required:
Demonstrated critical thinking, problem solving, project planning and implementation skills.
Demonstrate program development skills.
Demonstrated strong writing and communication skills.
Demonstrated ability to synthesize and analyze qualitative and/or quantitative data.
Knowledge of health care operations or health care systems.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
