Clinical Program Manager - PCHP

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Parkland Community Health Plan (PCHP) is part of Parkland Health. PCHP is a Medicaid Managed Care organization servicing Texas Medicaid and CHIP in the Dallas area. The Clinical Program Manager is responsible for tracking and monitoring regulatory deliverables, supporting the health services (physical health and behavioral health) teams with regulatory and internal audits, delivering training programs and overseeing the creation and evaluation of annual program descriptions, ensuring compliance with regulatory requirements, quality within the clinical team. This role ensures adherence to regulatory and accreditation standards while fostering continuous improvement within the clinical operations of the health plan.

Minimum Specifications

Education: Bachelor's degree in nursing, Healthcare Administration, Public Health, or a related field required; Master's degree preferred.

Experience: 2+ years of experience in clinical training, auditing or program development within a health plan or managed care setting. Strong knowledge of NCQA, CMS, Medicaid, TDI, and state regulatory requirements. Experience in case management, utilization management, or quality improvement preferred 

Certification/Registration/Licensure

• Must have current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.

Skills or Special Abilities

• Expertise in clinical auditing and compliance monitoring.
• Ability to develop and interpret reports using spreadsheet functions, such as formulas, graphs and formatting. 
• Strong training and presentation skills, with the ability to engage and educate diverse clinical teams. 
• Proficiency in project management task. 
• Experience developing and evaluating program descriptions and annual program reports. 
• Analytical and problem-solving skills to assess data and implement process improvements. 
• Excellent written and verbal communication skills. 
• Proficiency in clinical documentation systems, UM software, and Microsoft Office Suite. 
• Strong coaching and mentoring behaviors to learners utilizing effective feedback and motivational support techniques. 

Responsibilities 

Regulatory

• Ensure work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
• Conduct routine and targeted audits of clinical operations for physical health and behavioral health, that includes service coordination, utilization management, pharmacy, and care coordination processes to ensure compliance with all regulatory requirements.
• Identify trends, gaps, and risks in clinical documentation, decision-making, and workflow adherence.
• Provide targeted coaching and mentorship based on audit findings and staff performance assessments.
• Track monitor timely approval and submission of all regulatory deliverable, including HHSC, TDI and NCQA.
• Support the Clinical teams (PH and BH), with regulatory audits, including documentation preparation and submission.
• Track and monitor and lead projects to ensure end to end implementation of new regulatory requirements and mandates, including HHSC, TDI and NCQA within the Health Services team.
• Support management team in developing corrective action plans and collaborate with leadership to implement improvements.
• Prepare and present audit reports with recommendations for process enhancements.
• Ensure compliance with state, federal, and accreditation requirements (e.g., CMS, Medicaid, Medicare, NCQA). 

Operational

• Develop, maintain, and update the annual Utilization Management and Service Coordination Program Description, Workplan ensuring alignment with accreditation and regulatory requirements.
• Conduct annual Program Evaluations, analyzing outcomes, identifying areas for improvement, and incorporating best practices.
• Collaborate with key stakeholders to refine program goals, objectives, and metrics.
• Support the development and revision of policies and procedures related to clinical operations.
• Design, develop, and deliver training programs, including systems training for clinical staff, including nurses, care coordinators, and UM professionals. 
• Conduct onboarding training for new hires and ongoing education to maintain compliance with regulatory standards.
• Develop training materials, job aids, and policies to enhance staff competency and performance.
• Completes all relevant Train the Trainer courses and disseminates information in an organized and understandable fashion.
• Maintains training records that include attendance, course materials, syllabus, and certificates of completion.

Quality

• Integrate health literacy principles into all communication including Members and Providers.
• Support strategies that meet clinical, quality and network improvement goals.
• Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
• For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.

Stakeholder Collaboration & Continuous Improvement

• Work closely with clinical leadership, compliance, quality improvement, and provider relations teams to drive performance excellence.
• Serve as a subject matter expert (SME) for clinical program policies, workflows, and regulatory requirements for the Health Services department.
• Monitor industry trends and regulatory changes to proactively update programs, training, and audit methodologies.
• Facilitate communication and collaboration between departments to ensure a consistent approach to clinical quality and compliance.

Professional Accountability

• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements. Attends required meetings and town halls.
• Recognizes and communicate ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintains confidentiality at all times. Performs other work as requested that is reasonably related to the employee¿s position, qualifications, and competencies.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.