Sr Manager, Marketplace Program Development (Sr Manager II)
Sr Manager, Marketplace Program Development (Sr Manager II)
CalOptima
CalOptima Health is seeking a highly motivated an experienced Sr Manager, Marketplace Program Development (Sr Manager II) to join our team. The Sr Manager for Marketplace Program Development will be responsible for supporting the development of new programs and initiatives related to the implementation and ongoing management of new product lines, including commercial. The incumbent will be responsible for managing the regulatory and programmatic aspects of program implementation. The incumbent will collaborate with cross-functional business owners, Information Technology Services (ITS), Finance, the Office of Compliance and senior leadership to manage program governance and project structure, set program objectives and implement program requirements while working across the organization to understand dependencies for ensuring effective and efficient program delivery. The incumbent will establish, monitor and ensure the successful execution of regulatory filings and ongoing program submissions and maintenance.
Position Information:
• Department: Strategic Development
• Salary Grade: 317 - $132,969 - $212,751 ($63.93 - $102.2841)
• Work Arrangement: Partial Telework
**This position is eligible for telework in California.**
Duties & Responsibilities:
• 50% - Program Leadership
• Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
• Oversees the development of the Knox Keene Act licensure filing process, including collaboration with legal counsel, state regulators, consultants, internal business owners and staff to complete submissions.
• Oversees the development of the Qualified Health Plan application, supporting data and documentation submissions, including coordinating across multiple departments and developing processes for document creation and management, quality assurance and other activities to ensure a compliant and timely application submission.
• Fosters ongoing relationships and mutually beneficial partnerships with CalOptima Health departments and external organizations.
• Leads the execution of regulatory filings and applications required to support entrance into the marketplace.
• Develops, establishes and updates program management processes, policies, procedures, desktop protocols, forms, templates, reports and data to operationalize programs/processes and to maintain quality controls.
• Identifies opportunities for program efficiencies, develops new processes to support successful implementation and ensures sound organizational approaches across new lines of business.
• Collaborates with other leaders to ensure all programmatic aspects meet regulatory and contractual requirements for marketplace participation.
• Oversees programmatic reporting in partnership with business owners and IT.
• Collaborates with the Office of Compliance department on annual and ongoing audits.
• 45% - Program Development
• Tracks marketplace requirements, regulatory changes that impact the program, and engagements with program staff and leadership to ensure ongoing compliance and engagement.
• Partners with business owners, IT and consultants to develop and articulate programmatic requirements that impact program implementation.
• Partners with Enterprise Program Management Office (EPMO) project managers and leaders to ensure program implementation and workstreams remain on track and on budget.
• Ensures the program/project delivers the proper outcomes by developing and monitoring quantifiable values to track progress toward business objectives and proactively identifies and resolves challenges for performance improvement.
• Develops integrated program, resource and contingency plans and related program/project management artifacts to support successful implementation and execution of initiatives and programs.
• Monitors program related processes for legal, financial and regulatory compliance, including but not limited to ensuring adherence to policies and procedures and supporting audit activities.
• 5% - Other
• Completes other projects and duties as assigned.
Minimum Qualifications:
• Bachelor's degree in a related field PLUS 5 years of experience in managed care or other health care organization supporting program development or implementation required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 5 years of project and program management experience required.
• 3 years of management level experience required.
• Experience with organizational planning processes, program development, performance management or strategic improvement.
• Experience in developing processes and procedures and implementing best practices and efficient operations of initiatives.
• Experience and aptitude for working in a highly matrixed, fast-paced, mission-driven public agency required.
Preferred Qualifications:
• Experience working on a commercial or exchange/marketplace/Covered California line of business at a managed care organization.
• Experience interfacing with local, state or federal regulators.
Required Licensure / Certifications:
• n/a
Knowledge & Abilities:
• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):
• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Work Environment:
If located at the 500, 505 Building or a remote work location:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.
If located at PACE:
• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.
If located in the Community:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.
About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the https://alliantbenefits.cld.bz/25caloptimacabenguide regarding our comprehensive benefits and wellness package.
IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 5, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.
Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://apptrkr.com/6248348
Copyright ©2025 Jobelephant.com Inc. All rights reserved.
https://www.jobelephant.com/
jeid-45e69f1475d8e94abf75e9267f881cc7