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Program Manager Clinical, Principal

4 months ago

Woodland Hills, California, United States Blue Shield of California Full time

Your Role

The Care Management Department, which oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of NCQA (National Committee for Quality Assurance) standards. The Clinical Program Manager, Principle will report to the Director of Care Management. In this role you will provide oversight for clinical programs, ensuring alignment with organizational goals and objectives.

Your Work

In this role, you will:

Operate at a strategic business level to ensures projects/programs are in line with Blue Shield of California strategic goalsConsult with all levels including senior management, make recommendations, and influence decision-makingLeverage cross-functional internal and external relationships to drive initiatives forwardPlan and implement multiple and extremely complex projects/programs spanning across business areasDetermine key business issues, develop effective action plans and implement to successful conclusionAnalyze program data and metrics to identify trends, opportunities for improvement, and areas of risk.Assist with monitoring completion of regulatory activitiesLead initiatives to enhance the quality, efficiency, and effectiveness of clinical programs.Your Knowledge and ExperienceRequires a bachelor's degree or equivalent experienceRequires at least 10 years of prior relevant experienceRequires excellent analytical skills, with the ability to interpret complex data and make data-driven decisionsRequires 3-5 years Care Management experience in a health plan or other managed care settingIn-depth knowledge of compliance and regulatory requirements, with specific expertise in NCQA standards desiredRequires exceptional communication skills, both verbal and writtenRequires a valid California RN license

Pay Range:

The pay range for this role is: $ to $ for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.