Program Manager, Chronic Care Management Services

Program Manager, Chronic Care Management Services

Reporting to the Senior Director of Program Services and Administration, this position is responsible for successful implementation of the collaborative care model for patients with diabetes and hypertension. This position plays a key role to ensure clinical and fiscal operational efficiency of disease managments programs that also address the social determinates of health for patients. The program manager for Chronic Care Management Services will driveexcellence and provide facilitation of staff and stakeholder satisfaction.


· Serves as a team member for the Westside Health Equity Collaboration project contributing to success of achieving the Collaborative’s goals and effectively implementing activities and programming.

· Leads program management for CCM services, specifically targeting patients with diabetes and hypertension and focusing on practice employed community health workers, nurses, and other social supports workstreams to address social determinants of health and services coordination across provider entities

· Provides oversight and support to partner organizations implementing the Collaborative Care Model (CoCM) to improve outcomes.

· Contributes to the formation and implementation of clinical and operational initiatives using evidence-based practices to drive results

· Develops policies and procedures, program, and training materials for a variety of partners and collaborative learning models that may be disease, patient experience or operationally focused.

· Evaluates practices against performance goals and provides on the ground direction and oversight for advancement and continuous quality improvement.

· Ability to indirectly supervise and coach practice employed staff.

· Consults and collaborates with internal stakeholders such as MHN Chief Medical Officer, MHN Clinical Integration and Innovation team and other key leaders.

· Builds relationships with community based organzations, care delivery and educational partners/contractors; may serve as the liaison to these entities and function as the single point of contact for assigned providers.

  • Benchmarks key metrics and direct the collection of data to demonstrate value and drive success.

· Collaborates with Sr Program Director to draft program reports.

· Research innovative ideas and specific programs to presents findings and develops processes for implementation following approval.


  • Demonstrated ability to work collaboratively with a passion to contributing to a changing health care landscape and improving health care for marginalized communities
  • Minimum of 5-8 years of healthcare experience focused on Clinical Integration/Practice Transformation, Federally Qualified Health Centers, Hospitals, Ambulatory Care, Physician group; a combination preferred
  • Strong ability and skills in leading teams and taking projects from initiation to completion
  • Strong knowledge, skills and demonstrated completion of coursework in quality improvement, and project and data management
  • Demonstrated knowledge and experience with electronic information systems
  • Demonstrated knowledge and experience of systems to improve population health and disease management
  • Excellent oral, written organizational and interpersonal communication skills. Ability to work independently and to foster teamwork
  • Knowledge and experience working with NCQA, Joint Commission standards and requirements of state and federal agencies
  • Demonstrated experience in program development, training/education, management
  • Abilities to mentor staff at all levels throughout an organization.
  • Proficient computer skills
  • Knowledge of academic medical centers, safety net/public health hospitals, FQHCs and physician groups desirable
  • Excellent presentation skills and the ability to motivate collaborators towards participation in projects and initiatives
  • Ability to foster teamwork, and collaborative relationships across provider settings and diverse teams


Bachelor's Degree required in Nursing, Pharmacy, Nutrition, Social Work or other healthcare discipline. Master's degree in Nursing, Social Work, Health Services/Systems Administration, or Public Health strongly preferred. Other Master's Degrees may be considered as may years of applicable experience in lieu of graduate degree.