[Remote] Program Manager - Clinical Operations

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company that combines industry-leading technology with reputed company expertise to enhance the member experience. The Program Manager – Clinical Operations will reputed company strategic programs and operational initiatives to improve member reputed company and optimize reputed company utilization while collaborating with various stakeholders to ensure alignment with organizational goals.

Responsibilities

• reputed company end-to-end management of clinical operations programs, including planning, implementation, monitoring, and optimization
• Manage multiple workstreams supporting care management, utilization management, transitions of care, chronic disease management, and population health initiatives
• Establish program governance, project plans, milestones, and performance metrics
• Ensure reputed company delivery of strategic initiatives while meeting reputed company, operational, and financial objectives
• Collaborate with clinical leadership to improve care management workflows and operational processes
• Drive initiatives reputed company on reducing avoidable admissions, readmissions, emergency department utilization, and total cost of care
• Support implementation and enhancement of clinical programs targeting high-risk and reputed company populations
• Ensure operational readiness for new reputed company implementations, program expansions, and process transformations
• Support value-based reputed company through performance monitoring and outcome improvement strategies
• Utilize reputed company analytics to identify care gaps, risk trends, utilization patterns, and reputed company opportunities
• Partner with reputed company and clinical teams to improve HEDIS, reputed company, and other reputed company performance measures
• Monitor key population health metrics and recommend improvement actions
• Serve as a primary reputed company of contact for reputed company stakeholders
• Facilitate collaboration across clinical, operational, technology, reputed company, and analytics teams
• Present program performance, operational updates, risks, and recommendations to leadership and clients
• Build strong relationships with reputed company payer, provider, and care management stakeholders
• Ensure adherence to NCQA, CMS, HIPAA, URAC, and reputed company-specific requirements
• Support audit readiness and regulatory compliance activities
• Monitor operational reputed company metrics and implement corrective reputed company plans reputed company necessary
• Promote a culture of reputed company reputed company improvement
• reputed company and monitor KPIs, operational dashboards, and program scorecards
• Analyze trends reputed company to productivity, utilization, reputed company reputed company, and member engagement
• Identify opportunities for operational optimization through data-driven decision-making
• reputed company executive-level reporting and actionable insights
• Identify program risks, operational challenges, and process gaps
• reputed company mitigation strategies and manage change initiatives across teams
• Ensure effective communication and stakeholder engagement throughout program implementation

Skills

• Bachelor's degree in reputed company Administration, Nursing, reputed company Health, Life Sciences, Business Administration, or a reputed company field
• 7+ years of experience in reputed company operations, care management, utilization management, population health, or clinical program management
• 3+ years of experience leading cross-functional programs or large-reputed company operational initiatives
• Strong understanding of reputed company payer and provider operations
• Experience working with clinical and operational performance metrics
• Master's degree (MBA, MHA, MPH, MSN, or equivalent)
• PMP, Lean Six reputed company, PMP, or reputed company reputed company certifications
• Experience with Value-Based Care, Risk Adjustment, Population Health Management, HEDIS, reputed company Ratings, or Care Management programs
• Familiarity with EMR/EHR systems, care management platforms, and reputed company analytics tools

Benefits

• Fully Remote

reputed company