Program Manager Clinical, Principal
3 weeks ago
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 goals
Consult with all levels including senior management, make recommendations, and influence decision-making
Leverage cross-functional internal and external relationships to drive initiatives forward
Plan and implement multiple and extremely complex projects/programs spanning across business areas
Determine key business issues, develop effective action plans and implement to successful conclusion
Analyze program data and metrics to identify trends, opportunities for improvement, and areas of risk.
Assist with monitoring completion of regulatory activities
Lead initiatives to enhance the quality, efficiency, and effectiveness of clinical programs.
Your Knowledge and Experience
Requires a bachelors degree or equivalent experience
Requires at least 10 years of prior relevant experience
Requires excellent analytical skills, with the ability to interpret complex data and make data-driven decisions
Requires 3-5 years Care Management experience in a health plan or other managed care setting
In-depth knowledge of compliance and regulatory requirements, with specific expertise in NCQA standards desired
Requires exceptional communication skills, both verbal and written
Requires a valid California RN license
Pay Range:
The pay range for this role is: $ 136400.00 to $ 204600.00 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.
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