Clinical Operations Program Manager – Operating Model

This is a fully remote position, open to applicants in United States.

📋 Description

• Design, develop, construct, implement, and integrate workflows and system architectures for clinical programs.

• Oversee and manage clinical programs through data analysis, project planning, workflow design, system design, tracking, and execution.

• Facilitate continuous improvement initiatives through Plan-Do-Study-Act (PDSA) evaluations.

• Monitor and track requests for model impacts, workflows, product performance, and overall program efficacy.

• Collaborate with Training and Auditing teams on program documentation, system workflows, assessments, system design, and necessary updates.

• Partner with Clinical Operations Clinical Systems Configuration teams on program design, system development, and reporting functionalities.

• Assist in new business endeavors, including responses to RFPs and the implementation of clinical models.

• Work alongside Informatics, Analytics, and Reporting teams to ensure alignment of process changes with metrics and reporting standards.

• Engage with executives, stakeholders, and leaders across various markets and products to align programs with strategic objectives, regulatory compliance, and resource allocation.

• Provide regular updates and ongoing communication to senior management, stakeholders, and executive sponsors.

• Represent the clinical operating model in intake, governance, and prioritization processes.

• Monitor outcomes to pinpoint opportunities for enhancement in program design and application.

• Carry out additional duties as assigned.

⛳️ Requirements

• A Bachelor’s Degree in nursing, engineering, business management, or a related field, or equivalent years of relevant experience is mandatory.

• A minimum of five (5) years of experience in the healthcare sector is necessary.

• At least two (2) years of experience in product or program management is required.

• Exceptional proficiency with Microsoft Office suite tools, including Project, Word, PowerPoint, Excel, Visio, Teams, and Outlook.

• Strong analytical and reporting skills.

• Experience related to system design, program and project/process management.

• Skilled in interpreting analytics and insights.

• Knowledge of Utilization Management (UM), Case/Care Management (CM), and Behavioral Health (BH) healthcare domains is essential.

• Extensive experience in the healthcare payer industry along with knowledge of Medicaid and Medicare.

• Capability to understand and implement regulatory and contractual obligations.

• Ability to analyze processes across various functional areas.

• Competence to work autonomously as well as collaboratively within a team environment.

• Ability to review and implement evidence-based trends.

• Capacity to develop, prioritize, and achieve goals.

• A Master’s Degree in a related field is preferred.

• Project Management Professional (PMP) certification or equivalent training is preferred.

• Program Management Certification (PgMP) is also preferred.

• Registered Nurse (RN) or other clinical licensure is highly preferred.

• Certified Case Manager (CCM) is preferred.

🏝️ Benefits

• A bonus linked to both company and individual performance may be available.

• A substantial and comprehensive total rewards package.

• High potential for remote work opportunities.