Position Summary:

The Project Manager for Continuous Quality Monitoring Department (CQM), directly reports to Vice President of CQM. The role is responsible for leading regulatory audit projects. Set up internal monitoring projects to monitor the UM process, reporting and UM activities compliance. The role also needs to work with different departments to coordinate or lead projects that related to CQM to ensure the company Utilization Management Activity and Case Management Activities following the policies and procedures. The Project Manager will be responsible to analyze data to identify effectiveness of reporting and corrective actions as well as creating job aids/workflows for CQM team members to follow in the daily work.

Essential Duties and Responsibilities include the following:

• Lead Project of health plan annual audits and regulatory audits :
  • Audit schedule tracking/updating by using the data from internal team members
  • Organize meetings during preparation of audit to ensure successful audits and timeliness of submission
• Develop & analyze key reports/data to identify high value opportunities to improve operational performance and results.
• Lead the project of tracking and update P&Ps, presentation, meeting minutes for UMC.
• Internal audit to reflect CQM staff members' daily performance by working together with the CQM managers.
• Work collaboratively with different team members and clients from different business units to reach goals and accomplish tasks.
• Organize and facilitate the department meetings and trainings and keep documentation appropriately.
• Lead workplans projects for accuracy and timeliness workplan completion and submission by working together with the CQM managers.
• Lead prioritized & support any activities that may improve compliance and work quality in utilization management activities including:
  • Create and maintains project plans & timelines
  • Hold team members accountable for deliverables and to meet timelines
  • Assure needs of all regions are understood and addressed.
  • Resolve conflicts between CQM teams.
  • Coordinate activities with various stakeholders and other departments to keep projects on track.
  • Develops, in conjunction with subject matter experts, workflows, procedures & tools.
  • Develop and track metrics following implementation
  • Report progress to the management regularly
  • Report results post-implementation to the management regularly
  • Transfer to operational leadership
• Assists with the development and implement of training programs, as appropriate.
• Performs other duties as assigned

Key Skills include:

• Strong Organizational and time management skills.
• Effective verbal and written communication skills.
• Ability to interact effectively with a wide range of employees, customers and leaders.
• Knowledge of project management & project management software.
• Effectively documents activities.
• Effectively presents in a variety of settings.
• Proficient in Excel, Word, Outlook.

The pay range for this position at commencement of employment is expected to be between $70,304 - 75,0000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and / or Experience:

• Bachelor's degree strongly preferred.
• 1-2 years auditor/supervisor/ project management or program development and management experience in a health care setting or HMO.
• 3-5 years experience in managed care environment required.
• Demonstrated success leading groups and resolving conflicts.
• Experience working with all levels of management.
• Required to travel for provider office visits and to regional offices.
• Requires current CA driver's license and car insurance