Clinical Program Manager – Strategic Provider Partnerships

Clinical Program Manager - Strategic Provider Partnerships - INTEGRATED TELECOMMUTING OPTION! (Woodl

Clinical Program Manager - Strategic Provider Partnerships - INTEGRATED TELECOMMUTING OPTION! (Woodland Hills, Sacramento, Rancho Cordova, CA or Tigard, Oregon) - 12000236 Description Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs. For more information on Health Net, Inc., please visit the company's website at www.healthnet.com . JOB SUMMARY: CLINICAL PROGRAM MANAGER - Strategic Provider Partnerships - Integrated Telecommuting Option! Hiring 2 Clinical Program Managers The Clinical Program Manager (CPM), Strategic Provider Partnerships is responsible for identifying, managing and tracking clinical projects that advance the objectives of Health Net's Strategic Provider Partnerships (SPP). The CPM works closely delivery systems with whom Health Net has established unique, tightly-aligned business and clinical interests (Strategic Provider Partners). The CPM facilitates the development of clinical reports and the delivery of data to the Partners. The CPM works closely with the Medical Director (along with the SPP) to develop and implement key interventions to improve member experience, reduce unwarranted clinical variation and enhance transparency to customers. ESSENTIAL DUTIES AND RESPONSIBILITIES: Works collaboratively with Health Net staff and SPP counterparts to prioritize and develop clinical programs. Works collaboratively with SPP to jointly implement, track and refine these clinical programs. Manages multiple concurrent projects to support success of each SPP. Develops work plans, identifies and recruits appropriate team members, ensures effective communication of project requirements, tracks progress, keeps projects on schedule and refines as appropriate. Where appropriate, teaches and trains SPP Partners, clinicians or others in order to implement projects. Where appropriate, develops implementation aids or other tools to execute projects successfully. Develops internal reports to demonstrate progress of each SPP. Presents report findings at regular intervals. Describes potential project challenges, suggests course corrections and explains resource needs to keep projects on track. Develops external reports to demonstrate SPP value to employer community. Works with Health Net Clinical Accounts Management team to translate the successes of the SPP into talking points with employers and into industry presentations. Visits provider partners (medical groups, hospitals, skilled nursing facilities, etc.), as appropriate, to develop, track and refine clinical integration projects. Integrates SPP work with other Health Net medical management work regarding utilization management, quality improvement, Medicare Advantage programs, clinical pharmacy, behavioral health, web-based services, and other departments. As part of a team, develops, implements and executes medical management strategies with medical groups for compliance with standard guidelines, company policies and accepted business practices. Performs other duties, projects, and special assignments as assigned. Qualifications REQUIREMENTS: Education: Bachelor's Degree in Nursing or Master's Degree in Public Health (MPH) or Masters in Business Administration with associated health care experience Certification/License: If a Registered Nurse, active, valid and unrestricted state of CA or Oregon RN license required corresponding to the state wherein you reside. Experience: Five to seven years managed care experience, focusing on quality improvement, utilization management, or clinical operations Project management experience at a medical group, IPA, or health plan setting Facility in analyzing and presenting data to drive outcomes Confidence and competency making presentations in group settings At least two years management experience Knowledge, Skills Abilities: Ability to build and foster relationships with individuals at Health Net and in partner organizations Ability to develop creative approaches to clinical integration challenges Ability to lead/manage multiple projects simultaneously, meeting deadlines and balancing priorities Ability to motivate, persuade and influence others Ability to analyze data to identify opportunities and to track change Ability to present (both written and spoken) complex data in simple, actionable and clear fashion Demonstrate strong customer service and interpersonal skills Demonstrate strong attention to details Knowledge of strategies to enhance clinical quality, population health, and patient experience Knowledge and understanding of health care terminology, concepts (such as Accountable Care Organizations), and regulatory requirements PC skills with proficiency using Microsoft Office including, but not limited to, Word, Excel and PowerPoint, and software in functional area Up to 50% travel required OR Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position. Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening. Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D. Job - Health Services/ Clinical Primary Location - California-Woodland Hills Other Locations - California-Los Angeles, Oregon-Tigard, California-Sacramento, California-Rancho Cordova Organization - Health Net of California, Inc. - 4001 Schedule - Full-time Job Type - Regular Shift - Day Job Travel - Yes, 50% of the time Overtime Status - Exempt