Program Manager III, Prospective Medicare Risk Adjustment

Salary ranges outside of Northern California will be lower.

Overview: The Prospective Risk Adjustment Operations team is seeking a Program Manager to lead strategic initiatives that support prospective risk adjustment efforts. This role is responsible for planning, executing, and overseeing key projects, coordinating cross-functional teams, and ensuring successful delivery of program objectives. The Program Manager will drive operational improvements, support stakeholder engagement, and lead business analysis efforts for IT integrations that enable and enhance risk adjustment initiatives. The ideal candidate brings strong program and project management experience, analytical skills, and the ability to translate business needs into effective solutions.

Job Summary:

Manages small-to-medium sized projects/programs or components with multiple workstreams and strategic business goals across departments, functions, or regions with responsibility and accountability for achieving program outcomes from initiation to close-out in an extended or open-ended time frame. Leads the work of project/program teams by coordinating and monitoring internal and/or external resources. Monitors and identifies project/program risks, issues, and trigger events by executing mitigation plans and strategies. Monitors compliance of project/program activities by ensuring project/program plans and team members adhere to relevant policies and procedures. Ensures the alignment, buy-in, coordination, and support of diverse stakeholders. Assists with reviews of vendor performance levels, ensures service level agreements are met, and supports contract negotiations with vendors.

Essential Responsibilities:

Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.

Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.

Manages small-to-medium sized projects/programs or components with multiple workstreams and strategic business goals across departments, functions, or regions with responsibility and accountability for achieving program outcomes from initiation to close-out in an extended or open ended time frame. Develops, analyzes, and executes less complex project/program plans which include scope identification and management, schedule, inter-dependencies, and resource forecast. Manages project/program financials for small-to-medium size programs. Monitors project/program performance to ensure initiatives effectively deliver maximum long term value or benefit to the organization, and makes adjustments as needed in an uncertain environment where scope may be fluid. Manages project/program activities related to organizational change management (e.g., development and execution of user adoption, implementation, and training plans) as defined by the program. Allocates resources, establishes schedules, and makes task assignments.

Leads the work of project/program team members. Requests and coordinates internal and/ or external resources based on the alignment of team member skills and program demands. Promotes program vision and objectives with project/program team.

Monitors and identifies project/program risks, issues, and trigger events by executing mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.

Monitors adherence of project/program activities to policies and procedures by ensuring plans and team members follow KP, departmental, and/or business line policies and procedures.

Ensures the alignment, buy-in, and coordination of diverse stakeholders by building rapport with stakeholder teams, third party vendors, and management; and clarifying accountability and authority across stakeholders. Identifies and works closely with key stakeholders. Ensures all appropriate stakeholders are represented and included. Provides insight to key stakeholders and project/program sponsors by developing goals, setting the prioritization of deliverables, discussing involvement of business processes (e.g. program change management, communication) and facilitating decisions necessary for program delivery. Communicates tough issues to stakeholders while maintaining an independent opinion, providing recommendations, delivering presentations, and providing reports to stakeholders.

Assists with reviews of vendor performance levels and ensures service level agreements are met. Supports the contract negotiation process with vendors and reviews project/program invoices submitted by vendors for accuracy.

Knowledge, Skills and Abilities: (Core)

Ambiguity/Uncertainty Management

Attention to Detail

Business Knowledge

Communication

Critical Thinking

Cross-Group Collaboration

Decision Making

Dependability

Diversity, Equity, and Inclusion Support

Drives Results

Facilitation Skills

Health Care Industry

Influencing Others

Integrity

Learning Agility

Organizational Savvy

Problem Solving

Short- and Long-term Learning & Recall

Teamwork

Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

Applied Data Analysis

Change Management

Conflict Resolution

Financial Acumen

Managing Diverse Relationships

Project Management Tools

Quality Assurance Process

Risk Assessment

Service Focus

Strategic Program Management

Minimum Qualifications:

Bachelors degree from an accredited college or university and minimum three (3) years project management experience OR Minimum six (6) years experience in project management or a directly related field.

Preferred Qualifications:

Two (2) years experience working with database software (e.g., Access).

Two (2) years experience working with data analysis software (e.g., Minitab, QI Macros, Tableau, etc.).

PrimaryLocation : California,Oakland,Ordway

HoursPerWeek : 40

Shift : Day

Workdays : Mon, Tue, Wed, Thu, Fri

WorkingHoursStart : 08:00 AM

WorkingHoursEnd : 05:00 PM

Job Schedule : Full-time

Job Type : Standard

Employee Status : Regular

Employee Group/Union Affiliation : NUE-PO-01|NUE|Non Union Employee

Job Level : Individual Contributor

Job Category : Professional Services

Department : Po/Ho Corp - 3YP Core - 0308

Travel : No