DEPARTMENT(S):  Audit and Oversight REPORTS TO:  Director, Audit and Oversight FLSA STATUS:  Non-Exempt SALARY GRADE:  L - $77,000 - $109,000

JOB SUMMARY

The Project Manager provides coordination and staff support to ensure effective communication in developing and implementing special projects, programs, and new regulatory initiatives; project assignments may be with one department or multiple departments. The incumbent is responsible for the implementation of major regulatory initiatives and programs with organization-wide impact, which involves extensive coordination and representational responsibilities with higher level internal and external contacts, including governmental or regulatory agencies. This position fulfills a key role by interacting with all levels of CalOptima staff, providers, and external agencies.

POSITION RESPONSIBILITIES:

• Coordinate and support effective communication, on the development and implementation of special projects, programs, and new initiatives in a cross-functional capacity to ensure expectations are met.
• Effectively manage and communicate project updates, changes, risks, and tasks among the internal and external project teams.
• Guide and support project stakeholders through the project management process, navigating any problems that may arise and providing timely resolution.
• Implement cross-cutting initiatives and projects for the Audit & Oversight (A&O) Department, as well as other cross-functional regulatory initiatives across the organization.
• Draft, manage, assess, and propose organizational changes and coordinate revisions pertaining to various policies and procedures; audit work plans and results that affect the operations of A&O.
• Manage work plans, track progress and provide project summary updates to team members and management on internal functions, operational issues, process changes and activity status to ensure expectations are met.
• Manage key project initiatives associated with delegated vendor functions, monitoring and summarizing vendor oversight project progress.
• Participate in internal and external quality teams, cross-functional departmental planning sessions to improve overall organization performance.
• Collect data, analyze data/trends, report and present the A&O activities to management.
• Assist A&O in the annual strategic planning and work plan development process and provide support in carrying out same.
• Keep current on the local, state, and federal health care environment to identify public policy and market trends that may impact CalOptima’s programs and/or mission.
• Other projects and duties as assigned.

POSSESSES THE ABILITY TO:

• Evaluate and analyze regulations, interpret significance, recommend policies to comply and apply and ensure compliance to applicable regulations.
• Work with data, manipulate spreadsheets, and perform quantitative analyses.
• Work under minimal supervision and exercise independent judgment and tact in handling highly confidential information.
• Persuade and instill effective cooperation and compliance.
• Develop process flows, diagrams and/or other types of graphical illustrations.
• Develop rapport and facilitate cooperation, as well as recommend sanctions or corrective actions when necessary.
• Establish, interact, and maintain interpersonal relationships with all levels of staff, agencies, and stakeholders.
• Coordinate effectively with various departments, develop, and prepare coordinated responses and ensure uniformity and continuity.
• Work in a dynamic environment with both short-term and long-term deadlines.
• Organize and has keen attention to details.
• Communicate clearly and concisely, both verbally and in writing.
• Utilize computer and appropriate software (e.g. Microsoft Office: Word, Outlook, Excel, PowerPoint, Visio, Project Professional) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

EXPERIENCE & EDUCATION:

• Bachelor’s degree in a health-related field, or related area; or equivalent work experience required.
• 3+ years of experience in Project Management such as experience in project coordination, project planning, and implementation required.
• 3+ years of experience in a Health Care/Managed Care setting required.

PREFERRED QUALIFICATIONS:

• Active Project Management Professional (PMP) certification preferred.
• Familiarity with Medicare Advantage, Medicare Part D, Cal MediConnect, PACE, Medi-Cal/Medicaid managed care preferred.
• Familiarity with health plan operations as it relates to Medicare Advantage, Medicare Part D, Cal MediConnect, PACE, Medi-Cal/Medicaid preferred.
• Familiarity with health care programs and related issues at all levels --- local, state, and federal preferred.

KNOWLEDGE OF:

• Principles and practices of Medicare and Medi-Cal managed care.
• Federal and State regulatory and other requirements and practices related to Medi-Cal (Medicaid), Title 22, Knox-Keene, Medicare as well as other governmental and public sector operations and practices.
• Effective methods and techniques for persuasion and enforcement, compliance, and effecting change.
• Effective methods for managing staff and coordinating the work of interactive groups.
• Current trends and developments in healthcare, specifically Medicare and Medicaid.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

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Required Skills Required Experience