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  • San Francisco, CA

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Program Manager, Health Care

Blue Shield of California • San Francisco, CA

Posted 5 days ago

Job Snapshot

Experience - At least 2 year(s)
Degree - 4 Year Degree
Healthcare - Health Services


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Job Description

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

Job Requirements

The Clinical Program Manager, Quality Improvement, is responsible for the development and execution of targeted, clinical quality improvement (QI) initiatives in support of the PPO line of business.  This includes the design and development of contract language, pilots, toolkits and spread plans.  The incumbent also has accountability for aligning quality improvement initiatives with other lines of business (HMO, ACO, Medicare) and for ensuring that current and future QI programs align with long-term organizational strategies.
In partnership with other departments, the Clinical Program Manager will be accountable for building strong, collaborative relationships with targeted provider organizations.   The Clinical Program Manager is responsible for developing and managing communications about BSC’s quality improvement initiatives, through the development of RFI responses, contracts, toolkits and other methods.  Additionally, this position organizes interdepartmental activities and has some operational responsibilities.
In a results-oriented environment, the clinical program manager will execute data improvement efforts, incentive strategies and new improvement tactics to bring additional value to integrated health benefits.  To do this, the Clinical Program Manager is expected to coordinate with internal, cross-functional matrix teams, as well as with clinical leadership and staff in provider organizations.  The Clinical Program Manager will be responsible for participating in project teams and working with external vendors, assigning and monitoring work of team members and providing guidance and leadership to ensure timely execution of deliverables. This position may include limited accountability for managing budgets. 
Scope & Responsibilities:
•        Responsible for planning, execution and evaluation of large and complex program initiatives to improve quality performance.
•        Develops and monitors measurement strategies for large change and improvement initiatives.
•        Manages program(s) from initiation/pilot phase through delivery/spread and monitors for continuous improvement.
•        As part of a broader QI team, influences the business unit, strategies and objectives.
•        Becomes an expert in company quality initiatives, as well as the products, functions, marketing and/or service policies and procedures that support those initiatives.
•        Serves as a quality expert with internal constituents to drive successful improvement initiatives in the organization.
•        Educates and works with external partners and participating practices as needed to identify innovation opportunities and adopt improvement actions.
•        Exercises independent judgment in developing methods, techniques and evaluation criterion for obtaining results.
•        May assist in the planning and direction of budgets.
•        May act as the business unit liaison to corporate initiatives and projects.
Nature of Supervision:
•        Provides guidance and leadership to and may supervise project consultants and coordinators.
•        Ensures various team members provide high quality and cost effective services.
•        Demonstrates ability to work with and influence team members functioning in a matrix environment.
•        Demonstrates thought leadership, excellent project management skills, knowledge and experience with program evaluation and consulting skills.

Job Required Education/Experience

  •  Bachelor’s degree required in public health or similar discipline, Master’s preferred
  •  At least two years of experience in direct patient care setting.
  •  At least two years of healthcare experience in quality improvement and quality management.
  • Knowledge of HEDIS and accrediting body requirements (i.e.; NCQA or URAC) desired
  • Previous project/program management experience required.
  •  Experience in the CA delegated model or with highly integrated clinical delivery systems preferred
Job Additional Education/Experience Key Leadership to include: 
  • High integrity/ethics/trust
  •  Excellent communication skills, both written and verbal
  • Strong ability to drive for results
  • Strong facilitator with demonstrated excellence in driving multi-disciplinary and cross-functional teams to consensus
  • Demonstrated ability to influence in a healthcare environment
  • Seasoned critical thinking
  •  Ability to manage large, complex projects
  • Analytical skills—the ability to summarize complex information succinctly, using QI methodology as a guide
  • Experienced in Change Management Processes, including improvements and redesign
  • Skilled at facilitating and growing collaboration and motivation amongst geographically disperse teams
  • Strong interpersonal skills and demonstrated ability to build relationships in fast-paced environments
  • Financial/Quantitative acumen

Job ID: 17001UY
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