Job Details

Strategic Initiatives PM

W2 Contract-to-Hire

Salary Range: $156,000 - $176,800 per year

Location: Martinez, CA - Hybrid Role

Job Summary:

The ideal candidate will bring expertise in project management, healthcare, or health plan operations, and stakeholder engagement. They should have the ability to translate complex regulatory and operational requirements into sustainable process improvements that support compliance, efficiency, and quality of care.

Duties and Responsibilities:

• Regulatory Compliance: Map and standardize compliance workflows, refine internal audit tools, and develop proactive monitoring systems to ensure readiness for DHCS, DMHC, and CMS oversight. Build cross-functional reporting structures and dashboards (partnering with IT) to track risks and corrective actions.
• Claims Operations: Lead process mapping and redesign efforts to improve timeliness, accuracy, and cost efficiency in claims processing. Partner with IT to strengthen payment integrity, reduce interest penalties, and implement automation solutions while enhancing provider communication.
• Utilization Management: Standardize UM processes and templates across clinical teams, improve turnaround times, and support consistent clinical decision-making with Medical Directors. Develop dashboards and metrics to monitor timeliness, audit findings, and utilization trends, leveraging technology for efficiency.

Requirements and Qualifications:

• Possession of a Master's degree from an accredited college or university in nursing, behavioral science, business administration, public health, health care administration, or a closely related field.
• Two (2) years performing quality measurement or quality improvement activities in a health care or managed care setting or community mental health system.
• Possession of a bachelor's degree from an accredited college or university in one of the above-noted fields, plus two (2) years of additional qualifying experience, may be substituted for the Master's degree.

Desired Skills and Experience

Project management, healthcare operations, health plan operations, stakeholder engagement, regulatory compliance, process improvement, compliance management, efficiency optimization, quality of care, workflow mapping, standardization, internal audit, proactive monitoring, DHCS compliance, DMHC compliance, CMS compliance, cross-functional collaboration, reporting structures, dashboard development, risk tracking, corrective action management, claims operations, process mapping, process redesign, claims processing, payment integrity, automation implementation, provider communication, utilization management, UM processes, clinical operations, clinical decision support, medical director collaboration, metrics development, performance monitoring, audit management, utilization trends analysis, technology implementation, quality measurement, quality improvement, managed care, community mental health, nursing, behavioral science, business administration, public health, health care administration

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

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