Program Manager III - Payer and Network Strategies

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.   

As Program Manager III, you will manage the implementation and ongoing maintenance of designated programs, developing systems and procedures to ensure efficiency and effectiveness. In this role, you will oversee two to three state and federal value-based care contracts with Medicaid and Medicare, serving as a subject matter expert on contract performance and analytics. You will analyze performance data to identify gaps, collaborate with clinical teams to develop strategies for meeting contractual metrics, and prepare presentations to communicate findings and progress. This position serves as a liaison between the department and external communities, provides coaching and mentorship to staff, and participates in the budgetary process to support program goals.

The position is primarily remote, with Independence FHC as the primary on-site location for monthly visits.

Additional on-site visits to other facilities may be required based on business needs.

A caregiver who excels in this role will:

• Develop, implement, manage, and maintain operational systems and activities. 

• Serve as a liaison with all levels of the organization and outside the community. 

• Manage multiple priorities and projects with competing deadlines. 

• Allocate time to meet completion requirements. 

• Serve as a coach and mentor for other positions in the department. 

• Review and monitor adherence to Human Resources policies and corporate compliance procedures. 

• Other duties as assigned. 

Minimum qualifications for the ideal future caregiver include:

• Bachelor's degree in Business Administration, Healthcare Administration or related field and five years of related experience  

• OR Master’s degree and four years of experience  

• Knowledge of statistical and financial analysis, primary research and business plan development 

• Strong presentation, communication and training skills 
• Value based care experience

Preferred qualifications for the ideal future caregiver include:   

• Master’s degree 
• Healthcare experience
• Experience handling health insurance contracts
• Business analytics experience
• Experience using Copilot, Tableau, and Power Automate

• Ability to communicate and exchange accurate information. 
• Ability to perform work in a stationary position for extended periods.  
• Ability to work with physical records or operate a computer or other office equipment.  
• In some locations, ability to travel throughout the hospital system.  
• In some locations ability to move up to 25 lbs.

• Follows Standard Precautions using personal protective equipment as required for procedures.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/

Please review the Equal Employment Opportunity poster. 

Cleveland Clinic is pleased to be an equal employment opportunity employer.