Risk Adjustment Strategies and Initiatives Analytics Program Manager II

Job Summary

The Risk Adjustment Strategies and Initiatives Analytics Program Manager II plays a valuable role in executing high-impact risk adjustment system implementations to continuously improving data and reporting processes to increase the effectiveness of risk adjustment programs and operations Infrastructure. The Program Manager will structure and coordinate cross-functional teams on technical initiatives in risk adjustment data platforms. The Program Manager will work closely with Information Technology (I.T.) and Business leads to conceptualize solutions, organize and align multiple teams for data regression testing, track and monitor system test cases, and user acceptance deliveries and drive towards meeting risk adjustment key performance indicator (KPI) metrics and reports for all three lines of business (Commercial, Medicare and Medi-Cal). 

The Program Manager will standardize technical meetings and data discussions, ensure execution is efficient and consistent, and set accountability by tracking progress, resolving dependencies, identifying issues, evaluating risks, and communicating with cross-functional business partners. The Program Manager will  engage the analyst team to continue to support, test and upgrade multi-functional software programs for risk adjustment data collection and processing, often with tight deadlines and competing projects and priorities.  

The Program Manager will coordinate meetings, capture project discussions, develop project action plans, and complete business requirements and business case documents for technical implementations. Support and perform general data validation, clarify and address questions to drive projects and priorities. Track progress, coordinate with department analysts to resolve dependencies and evaluate risks, and communicate status to upper management and project partners. Serves as a resource on projects, technical documentation expert, and updates existing and develops new system architecture flow charts as risk adjustment activities evolve.  Oversees and administers all facets of the day-to-day operations of the various programs and activities related to the position. 

Duties

Develop, propose and implement program strategies and objectives.  Responsible for monitoring program budget and expenditures.  Plans, develops, and implements strategies for generating funding and/or resource opportunities for program activities.  

Provide program management and partnership with technical project team, and communicate and document concise project timelines, risks, escalation path, roles/responsibilities, and accountabilities.  
Facilitate technical meetings related to encounters and claims data for risk adjustment for all product lines (Commercial, Medicare, and Medi-Cal), capture notes and action plans.  Synchronize the work of cross-functional project teams and provide direct or indirect oversight scope of work. 

Evaluates and oversee the development and implementation of Centers for Medicare and Medicaid Services (CMS) and Department of Health Care Services (DHCS) risk adjustment program changes; incorporate changes and requirements into strategy. 

Develop and manage risk adjustment data Infrastructure programs and manage deliveries from beginning to end, including project scope, timeline, software or hardware requirements, resource allocation, and project execution coordinating with inter/intra Technical and Business Functional teams. Ensure program objectives and deliverables are in alignment with department and LA Care  goals.  Develop program initiative timelines, goals and ensure everything is on schedule and within stated budgets.

Serve as a liaison between all I.T. teams  to ensure alignment with project goal(s).  Coordinate cross-project activities.

Partners with Business Owner(s) to develop communications plan, test plan, training plan, risk management/mitigation plan, and plan of record. Monitor inter-connected programs/project work product, outcome and interplay to be able to make necessary enhancements or modifications as appropriate to ensure alignment with department objectives.  Coordinate cross-program/project activities as necessary.
 

Duties Continued

Formulate, organize and coordinate  inter-connected projects in encounter and supplemental data collections,  system processes, and regulatory data submissions for risk adjustment data management and methodologies for all three product lines (Commercial, Medicare, and Medi-Cal).

Develops and distributes reports for senior leaders as it relates to risk adjustment metrics and performance. .Assess program performance and aim to maximize return on investment (ROI), utilize change management strategies to implement enhancements and process improvements as necessary.

Navigate and create reports that monitors key performance indicators.  Ensures the accuracy and timeliness of report and data given to senior leaders and stakeholders.

Identify issues determined to impact risk adjustment, and work with the affected teams to resolve those issues in a manner that complies with all applicable internal and external governing rules and regulations.

Perform other duties assigned.

Education Required

Education Preferred

Experience

Required:
At least 5 years of experience in handling  encounter data and/or risk adjustment projects or programs.  

Experience with Process Improvement Methodology including defining and documenting workflow.

Experience with Workflow Tools - JIRA, Data Lake, Project Server etc.

Technical project experience in large distributed systems, complex competing environments, Micro services Architecture, Cloud computing etc.

Experience resolving effective program critical metrics and using them to measure program success and identify issues.

Experienced in project management tools. Familiar with both Agile and Waterfall methodologies and able to apply them when best suited.

Preferred:
At least 5 years experience in Health Care, Managed Care

Skills

Required:
Proven ability to work closely and skillfully with the all stake holders across the organization.

Strong organizational, analytical and truth-seeking mentality skills to juggle many tasks without losing sight of the highest priority or roadmap projects. 

Excellent in identifying process gaps, measuring progress, efficiency and balancing with process overhead and be exceptional at facilitating discussions.

Proven technical capability and an understanding of technical designs, challenges, and risks. 

Ability to influence, motivate, and align people across a broad variety of job functions through your project/program management skills. Basic understanding of IT driven technologies and Architectures.

Working knowledge of SQL Server, Visual Studio, Oracle, MS Office, Visio, Project Server & Jira Management

Ability to articulate and communicate effectively and follow the project management and Systems Development Life Cycle (SDLC) lifecycles.

Strong problem solving skills with the demonstrated ability to identify research and make decisions. 

Demonstrated ability to be an effective, collaborative partner with internal and external stakeholders.

Understanding of encounter and supplemental data collections,  system processes, and regulatory data submissions for risk adjustment data management and methodologies for Commercial, Medicare, and Medi-Cal product lines.

Have an understanding of end-to-end encounters/claims, supplemental, and risk adjustment data software systems.

Ability to lead cross functional internal teams to execute on complex tasks

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information