Program Manager II, Integrated Programs & Strategic Initiatives (Network Regulatory Compliance)

Job Summary

Essential Functions

• Responsible for managing complex cross functional projects to ensure regulatory compliance deliverables, including Alternative Access Delivery Request (AADR) submissions.
• Works with the Department lead and other relevant leads to ensure regulatory reporting goals, and workplan and tracking process; includes development of
• Provides regular communication and monitors progress to timeline and goals.

• Coordinates and manages complex research and analysis of polices and procedures to ensure compliance with regulatory requirements for health plan provider network applicable to Washington state (OIC, HCA, CMS to recommend solutions to develop innovations and strategy.

• Facilitates regulatory stakeholder engagement to support network compliance; coordinates input across relevant departments to identify key priorities, communications, track key deliverables and coordinate follow-up
• Prepares proposals, briefing documents, presentations, reports, applications, budgets and/or other documents associated with moving work plans forward. Working with communications and administrative support team members, assure effective systems related to program/project work and other communication tools and practices are in place.
• Responsible for development and management of contracts, including:
• Works with internal departments to ensure contracts are managed in a way that is in compliance with regulatory agencies Point of contact for Washington Health Benefit Exchange (WAHBE) for network directory data discussions.
• Develops and monitors scope, schedule and budget of contract or project and report results.
• Reviews and understands filing and contract requirements and changes.

• Organizes cross-team and-departmental collaboration and coordination with internal and external subject matter experts to develop system knowledge to support key strategic opportunities and system improvement strategies
• Provides ongoing monitoring and process improvement
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
• Exempt – Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.

Qualifications

Education

• Bachelor’s degree in Public Health or Health Administration or equivalent combination of education and highly relevant experience preferred

Experience

• 4-5 years of experience in Healthcare and program administration preferred

Employment Eligibility

• Complete and successfully pass a criminal background check
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency

Knowledge, Skills, and Abilities

• Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA).
• Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data
• Experience in care management workflow systems
• Effective verbal and written communication skills
• Flexibility and willingness to work in a matrix-management environment
• Demonstrated organizational, time management, and project management skills
• Ability to handle multiple priorities in a fast-paced environment
• Ability to multi-task and deal with complex assignments on a frequent basis
• Demonstrated proficiency and experience with Microsoft Office products
• Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers
• Ability to work independently
• Ability to present in a group setting
• Willingness to be part of a fast moving, and dynamic clinical development team
• Collaborate with others in a respectful manner
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.
• Meet attendance and punctuality standards
• Demonstrate professional courtesy to others and ability to maintain confidentiality