Under general direction, to plan, organize, direct and control the activities and/or staff of a County program.
The Program Manager II under Valley Health Plan’s (VHP) Provider Network Development unit will have independent accountability for strategies for building and executing engagement with providers, developing negotiation and contracting designed to achieve VHP's goal to create cost-effective and comprehensive provider networks to serve VHP’s members, and managing larger initiatives that result in savings in annual cost or geographic expansion. The incumbent will be responsible for ensuring best practices in negotiating and contracting to achieve overall health care cost targets, as well as contractual compliance with regulatory bodies and accreditation agencies (i.e., National Committee of Quality Assurance, Accreditation Association of Ambulatory Health Care, Department of Managed Health Care, etc.). The incumbent will also be responsible for developing of final written contracts and all associated documentation. Additionally, the incumbent may oversee a small team of contracting analysts, providing the team mentoring, support, and supervision in a designated area of services/specialties.
In addition to meeting the employment standards, a qualified candidate must possess one or more of the following:
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Experience in working with various provider types and specialties in a health plan network.
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Experience in ensuring compliance with regulatory and accreditation standards (i.e. DCHS, and DHMC, NCQA).
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Experience in negotiating contracts with provider networks that align with a health plan organization’s operational goal.
Sufficient education, training and experience to demonstrate the possession and direct application of the following knowledge and abilities.
Training and Experience Note: The required knowledge and abilities are typically attained through training and experience equivalent to possession of a Bachelor's degree. Relevant experience can substitute for education on a year-for-year basis. Relevant experience includes experience performing analytical, administrative, lead, supervisory, or management duties, which include interpreting rules and regulations, gathering data and formulating recommendations, and report writing.
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Five (5) years of analytical, administrative, lead, supervisory or management experience which includes duties interpreting rules and regulations, gathering data and formulating recommendations, and report writing; two (2) years of which must be at the journey level.
A Master's degree can substitute for one (1) year of the required experience.
Special Requirements
Specialized program knowledge may be required in addition to the generalized administrative/supervisory experience when it can be demonstrated that:
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it is an absolute necessity for the successful operation of the program;
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that the Program Manager will be held accountable for this specialized knowledge; and
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that subordinate program staff will not be able to provide the subject matter expertise that is required.
Note: The knowledge, skills and abilities listed below indicate the common aspects of the three levels of the Program Manager Series. However, for recruitment purposes, a potential candidate will be rated on ability to perform at a specific level as outlined in the allocation factors. In appraising experience, more weight will be given to the breadth rather than depth of pertinent experience and the evidence of the candidate's ability to assume and fulfill the responsibilities of the position at a designated level.
Some positions may require Live Scan screening as part of the background check process.
Knowledge of:-
Program development and evaluation;
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Techniques of organizing and motivating groups;
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Personnel management techniques;
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Methods of administrative problem solving;
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Principles of organization and administrative, fiscal and program management;
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Principles of employee supervision, training and development;
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Community and agency consultation methods and procedures;
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Computer applications, including but not limited to: word processing, spreadsheets, data base management software, presentation and electronic mail software.
Ability to:-
Plan, organize, control and evaluate a public service program;
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Manage initiatives, collect and analyze data for the purpose of evaluating services and or programs;
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Plan and assign workloads clearly and effectively;
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Train, develop and motivate staff;
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Deal effectively with a variety of government and community officials;
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Speak effectively in public;
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Integrate the activities of a program to attain program goals;
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Prepare and review reports;
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Develop and recommend effective courses of action;
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Develop and effectively utilize all available resources;
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Establish and maintain program's objectives, priorities and policies;
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Consult with and advise top administrator on the activities and status of the program;
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Develop short and long range budget plans that accurately reflect program needs.
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May require the ability to apply the tools of a specialty subject area.