Program Manager, Provider Data Operations

Program Manager, Provider Data OperationsCalOptimaJoin Us in this Amazing OpportunityWe are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.More About The OpportunityWe are hoping you will join us as a Program Manager, Provider Data Operations and help shape the future of healthcare where you'll be an integral part of our Provider Data Operations team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework.If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.The Program Manager (Provider Data Operations) will be responsible for collaborating and coordinating with leadership the planning, design and implementation of programs and initiatives that impact the teams within the Provider Data Operations department. You'll review and analyze regulatory and operational requirements and be responsible for full cycle implementation. Under the guidance of leadership, you'll develop a framework for execution, ensuring that programs are aligned with the organization's larger strategy, executed according to requirements and meet the needs of the department. Together, we are building a stronger, more equitable health system.Your Contributions To The Team90% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.Coordinates the planning, implementation and management of department initiatives and activities and works collaboratively with impacted business departments.Acts as a liaison and works with the Regulatory Affairs and Compliance department to analyze, track, implement and ensure delivery of regulatory requirements impacting the Provider Data Operations functional areas.Supports end-to-end implementation of regulatory, operational and technical requirements and ensures timelines and deliverables are fulfilled in cooperation with internal teams, third-party vendors and health networks.Conducts data quality checks, validates processes against requirements and identifies risks, gaps and resolutions.Completes statement of work and work-breakdown structure for projects and business plans for all lines of business.Collaborates with other department analysts in the development of program measures of success and outcome reports for programs.Creates and maintains thorough documentation, including policies and procedures, standard operating procedures (SOPs), job aids and training materials, following best practices for retention and accessibility.Provides analytical support and technical expertise on requests for information from management and other staff regarding provider-related issues and trends.Supports management and leadership by analyzing strategic options and providing data-driven recommendations.Stays current on the local, state and federal health care environment to identify public policy and market trends that may impact CalOptima Health's provider programs and/or mission.10% - Other Completes other projects and duties as assigned.Do You Have What the Role Requires?Bachelor's degree PLUS 3 years of experience in operations, data, project management and/or program management required, preferably in the health care industry or managed care environment; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.You'll Stand Out More If You Possess The FollowingMaster's degree.2 years of experience with managed care regulatory requirements.What the Regulatory Agencies Need You to Possess?N/AYour Knowledge & Abilities To Bring To This RoleDevelop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.Work independently and exercise sound judgment.Communicate clearly and concisely, both orally and in writing.Work a flexible schedule; available to participate in evening and weekend events.Organize, be analytical, problem-solve and possess project management skills.Work in a fast-paced environment and in an efficient manner.Manage multiple projects and identify opportunities for internal and external collaboration.Motivate and lead multi-program teams and external committees/coalitions.Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.Your Physical Requirements (With Or Without Accommodations)Ability to visually read information from computer screens, forms and other printed materials.Ability to speak (enunciate) clearly in conversation and general communication.Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.Lifting and moving objects, patients and/or equipment 10 to 25 pounds.Ways We Are Here For YouYou'll enjoy competitive compensation for this role. Our current hiring range is: Pay Grade: 311 – $77,863 – $124,581 ($37.43 – $59.8947).The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.This position is approved for Partial Telework (If the position is Telework, it is eligible in California only).A comprehensive benefits package.CalPERS pension program and additional retirement packages.Additional benefits and perks including: A generous PTO programA quality work life balanceVarious wellness programsTuition ReimbursementProfessional development opportunitiesCareer development opportunitiesFlexible schedulingAnd the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.Our Work EnvironmentIf located at the 500, 505 Building or a remote work location:Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.There are no harmful environmental conditions present for this job.The noise level in this work environment is usually moderate.If Located At PACEWork is typically indoors and a clinical setting serving the frail and elderly.There may be harmful or hazardous environmental conditions present for this job.The noise level in this work environment is usually moderate to loud.If Located In The CommunityWork is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.Employee will occasionally work outdoors in varied temperatures.There may be harmful or hazardous environmental conditions present for this job.The noise level in this work environment is usually moderate to loud.Why Join Us?We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impact on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.What's Your Next Step?All applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 24, 2026 at 9:00 PM (PST). We encourage you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.Legal StatementCalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health 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 Health 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 one of those characteristics.If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.Application InstructionsTo apply, please visit: https://jobs.caloptima.org/jobs/program-manager-provider-data-operations-505-city-parkway-west-california-united-states-5ab9859d-5a4d-4b1d-bec1-ca091168a1dcJ-18808-Ljbffr