Your RoleThe Special Populations Unit (SPU) ensures effective oversight and monitoring of vulnerable groups identified by CalAIM, advancing equitable access to care and improving health outcomes. Through cross-functional collaboration and data-driven strategies, we advocate for inclusive, person-centered solutions that promote the well-being of those we serve.The Program Manager Clinical, Principal will report to the Director of Special Populations Unit, Office of the Chief Medical Officer. Your role will focus on establishing strong collaboration and partnership with Utilization Management, Population Health Management (inclusive of Care Management, Transitional Care Services and Social Services), Behavioral Health and other clinical teams and assisting in the development of an oversight framework.

Your WorkIn this role, you will:Establish SPU program goals and performance metrics to ensure effectiveness and alignment with organizational objectivesAct as a clinical subject matter expert, providing guidance to stakeholders on program design and implementationFacilitate cross-departmental collaboration to drive alignment and integration of servicesCollect, analyze, and interpret clinical and operational data to assess program performance and impactIdentify trends, develop improvement plans, and implement evidence-based interventions.Help develop a compliance framework to ensure Special Populations programs comply with federal, state, and local healthcare regulations, as well as accreditation standards.Monitor policy changes affecting special populations and adapt programs as necessary.Contribute to strategic planning efforts to ensure programs align with long-term organizational goals.Consult with all levels including senior management, make recommendations, and influence decision-makingLeverage cross-functional internal and external relationships to drive initiatives forwardDetermine key business issues, develop effective action plans and implement to successful conclusionLead with a collaborative approach and an understanding of existing resources and relationships between/among partner organizations while moving them towards constructive change

Your Knowledge and ExperienceRequires a bachelor's degree or equivalent experienceRequires at least 10 years of prior relevant experienceMinimum of 10 years of clinical experience, including experience working with special populations (e.g., Medicaid/Medicare patients, individuals with complex health needs, or underserved communities)Requires current, active California RN, NP, PA, LCSW, LPCC, or LMFT license3-5 years Care Management experience in a health plan or other managed care setting preferredExcellent verbal and written communication style to drive positive outcomesProficiency in data analysis, reporting tools, and healthcare technologies (e.g., electronic health records).Familiarity with quality improvement methodologies, such as Lean or Six SigmaComprehensive understanding of healthcare regulations and accreditation standards, and payer programs (e.g., Medicaid, Medicare).Resourceful and collaborative: a team collaborator with strong listening skills and the ability to offer creative solutions to drive consensusDemonstrated cultural competence and a passion for serving diverse communities