We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Clinical Program Manager - DCE is responsible for the daily management and oversight of the DCE Medicare Program including Quality Management, Case Management, Disease Management, and Clinical Programs for DCE-Medicare. Assist in the clinical, quality, financial and patient outcomes for the Medical Group.

Job Responsibilities/Duties

• Develop and implement a fully integrated approach to care management to include inpatient, skilled, case management, quality, ER/IP costs, and reduction in overall costs.
• Develop and enhance programs to optimize collaboration and integration of programs for pre and post-acute care to achieve enterprise medical management targets and meet departmental objectives and metrics.
• Develop policy and procedures as required for departmental improvements.
• Create process flows, job aids, staff educational materials, and special projects when needed.
• Ensure compliance with all applicable regulatory and accreditation guidelines such as NCQA, DHCS, and CMS, according to the state of California.
• Participate in operational, inter-departmental and financial review meetings as required.
• Other duties as assigned.

Qualifications

Minimum Education: Bachelor’s Degree or equivalent education and experience required. BSN/MSN preferred.

Minimum Experience: Registered Nurse with a minimum of ten (10) years of experience in managed care required. Health Plan and IPA arenas to include Utilization Management, Quality Improvement, Inpatient Program and Case Management Program. Experienced with health plan guidelines/criteria and understanding of CMS/NCQA/DMHC regulations. Clinical background in acute and chronic care management.

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/