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, support change adoption, and contribute to workforce development initiatives.
• Advanced organizational, time management, and project leadership skills, with the ability to manage complex initiatives, balance competing priorities, and drive work to completion with minimal oversight.
• Highly effective verbal and written communication skills, including the ability to present complex topics clearly to diverse audiences, facilitate discussions, and influence cross‑functional stakeholders.
• Ability to work independently while exercising sound judgment and proactively identifying risks, gaps, and improvement opportunities.
• Consistently perform work with a high degree of accuracy, attention to detail, and accountability, meeting established timelines while supporting broader organizational goals.

To be successful in this role, you:

• Have a bachelor's degree or an equivalent combination of education and highly relevant experience.
• Have a minimum of five (5) years of experience in program management administration, including developing and/or implementing programs or leading teams that develop and implement programs in a healthcare setting
• Have at least three (3) years of experience in care management operations in a program management and or process improvement role, and one (1) or more years of mentoring, training, or teaching experience.
• Possess current, unrestricted licensure in the State of Washington as a Registered Nurse or as a Licensed Independent Clinical Social Worker.
• Have experience using Microsoft Office products, care management workflows, software applications, and reporting tools.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 68 and has a 10% annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year.
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.

Mental:

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.