Program Manager Clinical, Consultant

Your Role

The Population Health Management Social Services Clinical Liaison will report to the Director of Social Services, Medi-Cal Population Health Management. The Population Health Management Social Services Clinical Liaison interfaces with both DHCS and L.A. Care Health Plan; External Local Government Agencies and Providers including, but not limited to: County Child Welfare, County Behavioral Health and Enhanced Care Management (ECM) Providers; and, internal Blue Shield Promise staff including Population Health Management Care Management and Social Services staff, and ECM Program Management staff. The Population Health Management Social Services Clinical Liaison will serve as the primary point of contact to identify and resolve escalated Member-case specific, systematic, and operational obstacles for accessing services while providing programmatic support across Social Services program areas.

Your Work

In this role, you will:

• Manage medium to large sized projects (or multiple projects) spanning across business areas
• Ensure strategic direction of projects is in line and designs strategies for alignment with Company and business unit goals and objectives
• Proven ability to determine key business and technical issues, develop effective action plans and implement to successful conclusion
• Manage the design, development and/or implementation of new or enhanced systems projects or programs
• Manage the scope, schedule, budget, and quality of the project
• Support the Population Health Management Social Services Leadership Team in setting goals, providing direction, and supporting implementation of clinical initiatives with strategic partners in alignment with APL Memorandum of Understanding for Medi-Cal Managed Care Plans and Third-Party Agencies.
• Serve as a point of contact for internal and external staff and stakeholders to resolve escalated issues in a timely manner when Members experience difficulty accessing services, obtaining referrals, changing Providers, or facing operational obstacles to receiving health care services.
• Provide resources and support regarding Blue Shield Promise Member enrollment and disenrollment, when applicable.
• Assist with benefits and services navigation and coordination throughout Blue Shield Promise's service area to provide full-spectrum services to Members, including but not limited to: ECM, Community Supports, Behavioral Health, Transitional Care Services, Health Education, Home and Community Based Services, California Children's Services (CCS), Tribal health care, and other local service area resources.
• Collaborate with the internal ECM Program Management team and Blue Shield Promise contracted ECM providers to: ensure effective referral pathways exist for all Members eligible for ECM services; maintain collaborative working relationships; and, implement continuous quality improvement activities across the program.
• Attend quarterly meetings with local County agencies to address care coordination, quality improvement activities, quality improvement outcomes, systemic and case-specific concerns.
• Participate in and provides input for quality improvement activities associated with established MOUs between Blue Shield Promise and County agencies.
• Collaborate with the Blue Shield Promise County Liaison to ensure compliance with the training and education provisions of established MOUs.
• Enhance relationships between Blue Shield Promise and County agencies through participation in the MCP Community Advisory Committee and other MCP committees and meetings, including collaboration with other MCP Liaisons (internally and in other MCPs).

Your Knowledge and Experience

Current unrestricted CA License

• • LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences required
• Advanced degree commensurate with field is preferred
• Requires at least 7 years of prior relevant experience
• 3+ years of Medi-Cal (Medicaid) experience, including knowledge of benefits and applicable resources including enrollment and disenrollment processes preferred
• 3+ years of experience, expertise, or training in child welfare services, County behavioral health services, County care coordination and assessment processes, and trauma-informed care practices preferred
• 3+ years' experience in consulting, project management, data analytics, operations, or a related field preferred
• Excellent verbal and written communication style, coupled with strong data analytics skills, to drive positive outcomes
• Resourceful and collaborative: team collaborator with strong listening skills, emotional intelligence and the ability to offer creative solutions to drive consensus
• 3+ years' experience working with advanced Excel functions (formulas, pivot tables, lookup, macros, etc.) preferred

ABOUT THE TEAM

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.