Manager, Population Health Management (Chronic Conditions)

Department(s): Population Health Management
Reports to: Director II
FLSA status: Exempt
Salary Grade: N - $95,000 - $155,078

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 on Monday, January 01, 2024 at 11:59 PM.  Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. 

About CalOptima Health

Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health!

About the Position

The Manager Population Health Management (Chronic Conditions) will oversee the daily operations of the Chronic Conditions program activities and supervise assigned staff. Working under the Director's direction and in collaboration with department management, the incumbent will help develop goals and program priorities for the Population Health Management (PHM) department. The incumbent will be responsible for providing leadership to staff, overseeing program development and materials creation and supporting Health Management and quality improvement initiatives. The incumbent will serve as a resource for CalOptima Health stakeholders, ensuring improved health outcomes for members with Chronic Conditions. The incumbent will be accountable for establishing and achieving quality standards and compliance with regulations and department policies. This position requires excellent analytical, interpersonal, organizational and writing skills. A flexible schedule is essential for occasional evening and weekend event participation.

Duties & Responsibilities:

• Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
• Collaborates with PHM leadership to implement self-management population interventions for members with Chronic Conditions.
• Coordinates with various Medical Management departments to implement member-centric programs and services.
• Builds and fosters relationships with stakeholders, including trusted messengers, to promote prevention and management of Chronic Conditions, including offering services in community settings, overseeing the development of group classes on Chronic Conditions and building new partnerships with local community-based organizations.
• Leads and manages a team in developing, executing, evaluating and reporting on program initiatives.
• Oversees the referral process for members with Chronic Conditions and tracking of members to appropriate care levels.
• Identifies and uses technological tools to enhance program development.
• Analyzes best practices for Population Health Management and suggests improvements.
• Oversees the development and documentation of policies and desktop procedures for assigned programs.
• Ensures regulatory requirements are met and exceed all standards.
• Presents program updates to the Quality Improvement and Health Equity Committee and produces program evaluation reports for the Annual Quality Improvement Evaluation.
• Identifies opportunities and works with the Director to improve department efficiency.
• Develops and guides the implementation of special projects and pilots.
• Assists in the annual budgeting process.
• Oversees system activities and implementation related to Chronic Conditions programs.
• Ensures PHM participation in Interdisciplinary Care Team (ICT) meetings.
• Oversees PHM productivity standards for effective member outreach.
• Conducts regular program audits for quality assurance.
• Serves as a subject matter expert for Chronic Conditions, oversees specific PHM interventions and provides clinical guidance.
• Develops, revises and evaluates care management assessments, procedures and workflow processes.
• Develops, evaluates and revises risk stratification methodologies to identify members in need of intervention.
• Collaborates with Health Education and Quality Improvement staff to support HEDIS and quality improvement initiatives.
• Completes other projects and duties as assigned.

Experience & Education:

• Bachelor's degree in Health Sciences, Nursing, Nutrition or related field required.
• 5 years health education experience required, preferably in a managed care setting.
• 2 years of management experience.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
• Have access to means of transportation for work away from the primary office approximately 10% of the time required.

Preferred Qualifications:

• Master's degree in Health Sciences, Nursing, Nutrition or related field.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
• Project management experience.

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Job may require attendance at functions outside of the office and may require means of transportation to get to these locations.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal employment 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 of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation 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.