Program Manager III, Clinical Operations

**Who we are** | Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration. | ***Our commitment is to:*** Strive to apply an equity lens to all our work. Reduce health disparities. Create an equitable work environment. | | --- | --- | **About the Role** The Program Manager III, Clinical Operations partners closely with Clinical Services leadership to design, lead, and evolve care management programs and processes in alignment with organizational standards and regulatory requirements. This role provides subject matter leadership across program and project development for the care management function, driving continuous improvement through proactive process refinement, targeted auditing, and operational oversight. The Clinical Program Manager III is accountable for advancing operational efficiency, ensuring sustained compliance, and leveraging data and performance insights to demonstrate care outcomes and support strategic decision making. **Essential functions and Roles and Responsibilities:** - Develop and foster relationships with senior Care Management leadership through ongoing collaboration on process improvement initiatives related to operational efficiency, workflow management, and analytical support. - Oversee departmental projects, including identifying initiatives, developing project plans and timelines, and managing project work through completion. - Lead interdepartmental meetings, serving as a subject matter expert and educator to promote cross functional understanding of Care Management workflows and processes. - As needed, oversee and conduct regular internal audits of clinical staff performance, evaluating adherence to Care Management standards, regulatory requirements, and organizational policies, and provide feedback on performance gaps to staff leadership. - Ensure Care Management training meets all standards set forth by the National Committee for Quality Assurance, Healthcare Authority, Centers for Medicare and Medicaid Services, and other applicable regulatory bodies. - Collaborate with leadership to develop and implement new programs and enhance existing programs, including participation in and leadership of division-level initiatives in addition to Care Management-specific activities - Participate in internal cross functional teams to ensure care management programs meet regulatory and compliance requirements. - Serve as a resource and support for more junior Program Managers, delegating responsibilities as appropriate to help broaden team skillsets and balance work efforts within the department. - Serve as a liaison between data analytics staff and Care Management leadership to develop or modify care management reports used to assess productivity and program outcomes. - Produce care management reports and present findings to applicable leadership and or committees. - Identify opportunities to standardize and improve care management processes and partner with leadership and staff to implement efficient desk procedures across lines of business. - Perform other duties as assigned. Essential functions listed are not exhaustive and may be revised by the employer at its discretion. **Knowledge, Skills, and Abilities:** - Advanced knowledge of regulatory and accreditation requirements and their enterprise‑level impact, including HEDIS, CAHPS, NCQA, and related state and federal standards, with the ability to interpret and apply requirements across programs and workflows. - Deep understanding of care management operations and standards, including utilization management, benefits administration, and NCQA requirements, with the ability to guide program design and continuous improvement. - Applied expertise in adult learning principles, including the ability to influence training strategy, su…