Manager, Performance Programs

Job Description

The Performance Program Manager is responsible for the planning, organization, and successful execution of one or more performance programs for the company. Program consists of CMS STAR management to reach the highest attainment possible P4P, HEDIS, and Total cost of Care. The PPM is responsible for the motivation of the team to achieve measurable gains within the programs, as measured by internal and external metrics. Ensures the quality and timeliness of work performed, supervises and assists in the gathering of data (supplemental or otherwise) and the accurate entry into all systems and subsystems. Coordinates communications between members, staff, providers and Health Plans. Demonstrates the ability to work on multiple, complex projects and manages communication between staff, providers, health plans and members.

Responsibilities

• Manage, select, hire, train and motivate staff to achieve day-to-day and long- range operational goals.
• Coordinate resources required to meet the business units’ objectives. Manage the resolution of problems that are escalated.
• Continually review and appraise the progress and performance of staff and design developmental programs tailored to meet their career goals. In conjunction with the Director, establishes yearly department goals.
• Continually assess potential project risks and creates and implements corrective action plans and develops new procedures resulting in additional revenue for the company.
• Initiates new programs, enhances existing programs and continuously assesses need for resources, tools and add-ons.
• Provides excellent and comprehensive communication and education to internal and external staff and customers.
• Assists with Provider, staff and member training. May coordinate and oversee annual chart audits collection, HP chart requests, claim or payment resolution, etc.
• Initiates member and provider communication relating to missing tests, measures and “due” reports.
• Produces accurate staff and “measure” productivity reports in a timely manner.
• Identifies areas that need improvement and initiates creative solutions (cost effective) to correct problems.
• Ensures proper notification to clients and customers has been performed.
• Produces accurate metrics reports as well as staff productivity reports in a timely manner.
• Identifies areas that need improvement and initiates creative solutions (cost effective) to correct issues to meet and exceed our stated goals.
  
  

Qualifications

Minimum Education: Bachelor's Degree with emphasis in business administration, IT or Health care preferred or equivalent experience.

Minimum Experience: Five or more years’ experience in project coordination or management of small, medium and large projects desired. Experience in health care desirable.

Req. Certification/Licensure: None.

"Location-Based Pay Adjustment"

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.