The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

We are currently hiring a Program Manager, Quality Improvement & Health Equity to join our team.

Must reside in California - remote position.

What You Will Be Doing:

Under limited supervision, the Quality Improvement and Health Equity Program Manager is responsible for supporting and developing department projects and initiatives in a manner that ensures regulatory, accreditation compliance, and meets best practices. Responsible for contributing to Quality Improvement initiatives and managing Health Equity programs while identifying opportunities for the Health Plan to provide effective, equitable, and high-quality care and services that are responsive to diverse cultural health beliefs, practices, preferred languages, health literacy, and other communication needs of our members and community. Responsible for developing and implementing consistent business processes in collaboration with other Health Plan departments to fulfill Quality Improvement and Health Equity objectives and regulatory requirements, including management of the Cultural & Linguistics program. Responsible for the successful planning, execution, and delivery of programs, ensuring alignment with organizational strategic goals and objectives.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions:

• Collaborates with teams across multiple functional areas and with external stakeholders, including community partners, to design, implement, and operationalize projects and programs centered on reducing disparities, building equity, and measuring success with industry best practices.
• Collaborates with member-facing departments to develop action plans for quality and health equity best practices; monitors progress and implements appropriate interventions based on results.
• Collaborates with multiple teams to monitor and improve the collection of accurate and reliable demographic data to monitor and evaluate quality, equity, and clinical outcomes to inform health service delivery.
• Collaborates with the Quality, HEDIS, Accreditation, Health Education and other teams as needed to implement interventions.
• Participates in development of grant proposals and community funding efforts related to health equity, including proposal review, research and scoring.
• Participates in Request for Proposal (RFQ) processes to support the appropriate selection of vendors.
• Partners with the external groups (e.g. provider entities, community-based organizations) to design, implement, and evaluate policies, practices, and services to ensure appropriateness of health equity initiatives for the given population of focus.
• Implements strategies designed to identify and address root causes of health inequities including but not limited to systemic racism, social determinants of health, and infrastructure barriers for Health Plan members and providers.
• Manages the Cultural and Linguistic Services Program and is responsible for building initiatives and process improvement that are informed by the diverse cultural and linguistic needs of the service area. Owns operational functions of the Cultural and Linguistic Services program as assigned by the Director of Health Equity, overseeing some day-to-day activities and addressing operational issues as needed.
• Provides project management and operational support to the C&L team and related activities for the health plan including translation services and interpreter services and ensures compliance with the Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA) accreditation requirements, as well as the federal department of Health and Human Services.
• Conducts regular assessments of community health assets and needs, using the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.
• Assesses and communicates the Health Plan service area counties’ health assessment reports and suggests goals and objectives for the Health Plan that align with the report findings, and that are designed to drive improvement.
• Develops quantifiable metrics that can track and evaluate the results of the targeted interventions designed to eliminate health inequities.
• Develops relevant, timely and accurate internal and external quality and health equity reports, advising leadership as appropriate.
• Monitors, analyzes, builds presentations, and reports on the effectiveness of Health Equity and C&L activities at key internal committee meetings; takes actions based on results.
• Ensures organizational policies, procedures, and programs consider health inequities and are designed to promote health equity across all business areas, including but not limited to, marketing strategies, medical and other health services policies, member and provider outreach, the community advisory committee, quality improvement activities, health delivery system reforms, grievances and appeals, and utilization management.
  
  

What You Bring:

Knowledge, Skills, Abilities and Competencies

Required

• Basic knowledge of HEDIS standards and healthcare quality metrics.
• Basic knowledge of data management principles in health care settings, especially as pertains to the management and utilization of demographic and SDOH data.
• Basic knowledge of and skills in change management theory and practice.
• Intermediate skills in data collection and analysis and dashboard reports development.
• Intermediate skills in Word, Excel, and PowerPoint.
• Intermediate knowledge of the principals and practices of managed care (Medi-Cal, Medicare) and other state sponsored programs.
• Strong project management skills, with ability to readily create, execute, and monitor project progress and impact relevant objectives, from the corporate to department level. Ability to complete project documents, select and organize project teams, exercise authority, and achieve buy in.
• Ability to create relevant health-related surveys for internal and external stakeholders.
• Knowledge of the healthcare issues and challenges commonly encountered by the Medicaid/Medicare population, as well as vulnerable subpopulations.
• Able to interpret and apply understanding of key financial indicators to make better business decisions and develop budget.
• Sees ahead to future possibilities and translates them into breakthrough strategies.
• Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
• Very strong oral and written communication skills with the ability to communicate professionally and persuasively to diverse individuals and groups inside and outside of Health Plan, including development of materials for multicultural and low literacy populations.
• Very strong interpersonal skills with the ability to establish and maintain effective working relationships with diverse individuals at all levels inside and outside of the Health Plan.
• Strong presentation skills with the ability to effectively explain complex information and tailor presentations to a specific audience.
• Demonstrated ability to articulate and support Health Plan’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
• Ability to handle confidential information with appropriate discretion.
• Strong knowledge of federal and state laws, standards and regulations, including Medi-Cal and/or Medicare and HIPAA, in managed care organizations. Ability to read, interpret and apply complex written regulations, guidelines, and other materials.
• Ability to read and interpret basic clinical information.
• Advanced skills in skills in Word, Excel, and PowerPoint.
• Bilingual (Spanish or other primary languages spoken by Health Plan members).
  
  

What You Have:

Education and Experience

Required

• Bachelor’s degree with a major in linguistics, public health, health science, nursing, social work, or closely related field or equivalent direct work experience; and
• At least 5 years’ experience in health equity, cultural & linguistic services, or quality program development and implementation; and
• At least two years supervisory, project, or program management experience.
  
  

Preferred

• Master’s degree with a major in linguistics, public health, health science, nursing, social work, or closely related field or equivalent direct work experience or closely related field.
• Managed care experience.
• Experience in health education or quality activities for Medi-Cal or other state-sponsored programs (WIC, CalFresh, et al).
• Experience with building initiatives around NCQA Accreditation requirements and HEDIS scores.
• Medicare Advantage experience in healthy equity, quality, or cultural and linguistic services,
  
  

Licenses, Certifications

Preferred

• PMP or other project management certification.
• CHLA Interpreter Competency Assessment; CCHI Certification; ATA Certification.
  
  

HPSJ Perks:

What You Will Get:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
  
  

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.

Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.