Program Manager

• Leads development and execution of compliance, quality, and delegation policies while designing and implementing division and corporate-level projects related to accreditation and delegation activities
• Establishes long-term departmental goals in conjunction with division leadership, maintains quality management frameworks that support continuous improvement culture, and drives best practice adoption across all business functions
• Communicates and interprets laws, regulatory procedures, and accreditation standards while ensuring legislative, regulatory, and accreditation changes are promptly identified and implemented across the organization
• Develops, maintains, and revises policies, procedures, and audit tools for oversight of delegated functions including credentialing, utilization management, case management, appeals, claims, and network management
• Conducts periodic oversight reviews of delegated entities, prepares final reports identifying deficiencies, develops corrective action plans with timelines, and escalates mandatory standard deficiencies while monitoring entity performance
• Champions quality improvement best practices by mentoring team members in QI methodologies (Lean, Six Sigma, PDSA cycles), fostering data-driven decision making, and leading projects that drive measurable organizational transformation
• Collaborates with leadership and cross-functional teams to identify improvement opportunities, serves as primary quality management subject matter expert providing guidance across departments, and facilitates knowledge sharing and best practice dissemination
• Develops and executes quality management strategies aligned with organizational goals, monitors quality trends, analyzes performance data, and recommends corrective actions to senior leadership while ensuring regulatory compliance and driving innovation
• Manages financial targets, department budget, and workforce allocation while overseeing project plans to ensure deliverables meet compliance and regulatory standards
• Defines business requirements for delegation-related reporting and data systems, manages design and control of delegation reporting systems, and tracks corrective action plans from internal monitoring and external audits

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