Clinical Operations Program Manager – Operating Model

CareSource

. Design, develop, build, implement, and integrate clinical program workflows and system designs .

Posted 9/30/2026full-timeRemote • United StatesMid-LevelSenior💰 $113,000 - $197,700 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical program design and management, with a strong focus on data analysis, system design, and regulatory compliance. Proficient in collaborating with cross-functional teams to enhance program performance and implement evidence-based practices.

Highest-signal resume keywords

Clinical Program ManagementData AnalysisSystem DesignHealthcare Payer Industry KnowledgeRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Program ManagementProject ManagementWorkflow DesignAnalytics InterpretationEvidence-Based Trends Implementation

Soft Skills

CollaborationCommunicationIndependent WorkGoal Prioritization

Tools & Technologies

Microsoft OfficeMicrosoft ProjectMicrosoft ExcelMicrosoft PowerPointMicrosoft VisioMicrosoft TeamsMicrosoft Outlook

Certifications & Qualifications

Project Management Professional (PMP)Program Management Certification (PgMP)Registered Nurse (RN)Certified Case Manager (CCM)

Industry Keywords

Utilization Management (UM)Case Management (CM)Behavioral Health (BH)MedicaidMedicare

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Design, develop, build, implement, and integrate clinical program workflows and system designs
Develop and manage clinical programs through data analysis, project planning, workflow design, system design, tracking, and implementation
Support continuous improvement through Plan-Do-Study-Act (PDSA) reviews
Monitor and track model impact requests, workflows, product performance, and program performance
Collaborate with Training and Auditing teams on program materials, system workflows, assessments, system design, and updates
Collaborate with Clinical Operations Clinical Systems Configuration teams on program design, system build, and reporting capabilities
Support new business activities, including RFP responses and clinical model implementation
Collaborate with Informatics, Analytics, and Reporting teams to align process changes with metrics and reporting standards
Work with executives, stakeholders, and leaders across markets and products to align programs with strategy, regulatory requirements, and resourcing
Provide regular reporting and ongoing communications to senior management, stakeholders, and executive sponsors
Represent the clinical operating model in intake, governance, and prioritization processes
Monitor outcomes to identify opportunities for improvement in program design and application
Perform other duties as requested

Requirements

What you’ll need

Bachelor’s Degree in nursing, engineering, business management or related field or equivalent years of relevant experience is required
Minimum of five (5) years of healthcare experience is required
Minimum of two (2) years of product or program management experience is required
Excellent proficiency with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc.
Excellent analysis and reporting skills
Skills related to system design, program and project/process management
Skilled in interpretation of analytics and insights
Knowledge of Utilization Management (UM), Case/Care Management (CM) and Behavioral Health (BH) healthcare domain is required
Strong experience in the healthcare payer industry and knowledge of Medicaid and Medicare
Ability to understand and implement regulatory and contractual requirements
Ability to analyze processes across multiple functional areas
Ability to work independently and within a team environment
Ability to review and implement evidence based trends
Ability to develop, prioritize and accomplish goals
Master’s Degree in related field is preferred
Project Management Professional (PMP) or equivalent certification/training is preferred
Program Management Certification (PgMP) is preferred
Registered Nurse (RN) or other clinical licensure is preferred
CCM preferred

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
High potential for remote work