Clinical Quality Program Manager, Senior

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

Description

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!

Your Role

The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Project Manager will report to the Senior Manager. In this role you will be responsible for creating and facilitation training strategies/programs to support an operational team responsible for abstraction and pursuit of HEDIS measures to ensure they reach operational milestones, gap closures, rates, and overall successful quality standards.

Your Work

In this role, you will:
  • Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation
  • Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities
  • Review program budget variance and scope change requests, and participate in the budget-resolution process
  • Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
  • Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives
  • Manages, coordinates, and facilitates HEDIS training, including HEDIS software training, admin and hybrid measure training and creating training materials
  • Coordinate's training related to external client facing program; develops program success measures and performs periodic assessments of program success
  • Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results
  • Manages the HEDIS Roadmap submission: Co-wrote all narrative descriptions, updated project timeline, updated company policies, and conducted outreach to all parties responsible for other sections to ensure timely delivery of the whole
  • Participate in ad hoc meetings: Provide communication support to vendors, as needed; Identify and isolate issues to minimize interruptions to workflow




Qualifications

Your Knowledge and Experience
  • Requires a bachelor's degree or equivalent experience
  • Requires at least 5 years of prior relevant experience
  • Clinical field with at least 5 years of experience in health care quality and/or data analysis experience; or any combination of education and experience, which would provide an equivalent background
  • Knowledge of HEDIS quality measures
  • Knowledge in HEDIS technical specifications and HEDIS Value set
  • Strong background in project management
  • Expert proficiency in MS Word, Excel, PowerPoint, Access, and Project

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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes
  • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals


Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
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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.
COVID-19 update: From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a federal contractor and a health care company, Blue Shield requires all employees to be fully vaccinated prior to start date as a condition of employment and provide proof of vaccination status. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date
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