Program Manager, Senior

Your Role

The Quality Improvement Team is accountable for quality ratings of the organization and the development and execution of targeted, quality improvement initiatives in support of the commercial medical groups, hospitals, affiliated providers, and our CalPERS membership. The Program Manager, Senior will report to the Manager, Program and Project Management. In this role you will be responsible in the commercial line of business for the development and execution of targeted, quality improvement initiatives with our external provider group partners to achieve improved outcomes in HEDIS measures. You will partner with other lines of business and align quality interventions to the organizational strategies for HEDIS, QRS, CAHPS, and our CalPERS membership. The Program Manager will manage to data driven outcomes and targets helping to facilitate getting provider data into our Blue Shield systems.       

Your Work

In this role, you will:

• Direct small-scale, complex programs/projects that may involve multiple internal and external stakeholders  
• Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products 
• Be responsible for assembling a project team, assigning, and monitoring work of team members and providing guidance and leadership
• Develop the program, integrated program plan, resource plan, contingency plan, and related project management artifacts 
• Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan

• Be responsible for planning, execution, and evaluation of large and complex program initiatives to improve quality performance in the commercial line of business

• Educate and work with internal and external partners as needed to identify innovative quality improvement opportunities and adopt improvement actions

• Demonstrate thought leadership, critical thinking, excellent project management skills, knowledge and experience with program evaluation and consulting skills

• Perform other duties as assigned by management

• Manage a portfolio of provider groups and be accountable for key quality measure improvements through building stronger partner relationships and data channels into Blue Shield’s data systems 

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience

• Requires at least 5 years of prior relevant experience

• A clinical license (i.e. LVN, RN, NP, PA, MSW, CPhT, etc) strongly preferred

• Requires experience in driving performance within Quality Rating Systems, specifically NCQA, HEDIS, and CAHPS measurement 

• Requires demonstrated experience in executing quality improvement or process/performance improvement with a measurable outcome or data supported impact, including performance improved or member experience impact, either in a health plan quality team or in an outpatient healthcare setting

• Requires previous project/program management experience including planning and monitoring projects/programs from initiation through delivery 

• Requires demonstrated facilitation skills that resulted in measurable impact to HEDIS or CAHPS outcomes

• Highly adept computer skills; demonstrated mastery of all MS Office products (including Outlook, Excel, PowerPoint, Word); ability to analyze and manipulate data