[Hiring] Clinical Operations Manager @CareOregon

Role Description

The Clinical Operations Manager - Medicare is responsible for the operational execution, performance management, and continuous improvement of clinical programs that support the Dual Eligible Special Needs Plan (D-SNP) Model of Care (MOC). This role ensures that care management, care coordination, interdisciplinary care teams (ICTs), health risk assessments (HRAs), and individualized care plans (ICPs) are implemented effectively, compliantly, and consistently within Medicare. The Manager serves as a key operational leader, translating strategic clinical initiatives into day-to-day workflows that improve quality outcomes, member experience, health equity, regulatory compliance, and operational performance. This position works closely with Care Management, Quality, Population Health, Provider Relations, Pharmacy, Behavioral Health, ISBI, and Compliance teams to ensure successful delivery of D-SNP programs and services.

Qualifications

• Minimum 5 years of experience in healthcare operations, care management, population health, or quality improvement
• Master’s degree in Healthcare Administration, Public Health, Social Work, or related healthcare field
• Preferred: Registered Nurse / RN, Certified Case Manager, or Project Management Professional
• Preferred: Certified Professional in Healthcare Quality (CPHQ)
• 3 years of Medicare Advantage, Medicaid Managed Care, SNP, or D-SNP experience
• Minimum 2 years of experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program

Requirements

• Advanced knowledge of Medicare Advantage and D-SNP operations
• Advanced knowledge of CMS Model of Care requirements
• Advanced knowledge of care management and care coordination practices
• Knowledge of population health management principles
• Knowledge of quality improvement methodologies
• Advanced knowledge of healthcare regulatory and compliance standards
• Advanced knowledge of health equity and social determinants of health
• Knowledge of healthcare operational metrics and reporting
• Excellent operational planning and execution skills
• Excellent project and program management skills
• Excellent process improvement and workflow optimization skills
• Data analysis and performance measurement skills
• Audit preparation and compliance management skills
• Excellent change management skills
• Excellent reading, oral, and written communication
• Ability to effectively collaborate with leadership and staff, and other stakeholders
• Ability to utilize care management platforms and clinical documentation systems
• Ability to effectively use Microsoft Excel, Power BI, Tableau, or similar reporting tools
• Ability to develop Medicare reporting requirements
• Ability to develop performance dashboard
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Benefits

• Competitive pay
• Bonus opportunity
• Comprehensive benefits package including medical, dental, vision, life, AD&D, and disability insurance
• Health savings account, flexible spending account(s), lifestyle spending account
• Employee assistance program, wellness program, discounts, and multiple supplemental benefits
• Strong retirement plan with employer contributions
• PTO and Paid State Sick Time based on hours worked/scheduled hours
• Paid holidays, volunteer time, jury duty, bereavement leave, and more