Program Manager, Principal

Your Role

The Provider Partnership team is responsible for managing and maintaining the relationships with providers and leveraging these relationships to optimize performance and improve the overall satisfaction of our provider partners.. The Program Manager, Principal will report to the Sr. Director, Provider Partnerships, Southern California Region. In this role you will partner with the providers in your assigned regions to improve costs, quality, service, and membership growth across all lines of business.

Your Work

In this role, you will:

• Operate at a strategic business level to ensure 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, implement and execute to successful conclusion.    

• Validate financial forecasts and provide on-going reconciliation of resources and other related program expenditures.   

• Responsible for the overall relationship and tracking performance results of assigned providers. Hold internal BSC teams accountable to ensure provider satisfaction. Drive to provider performance among tactical team. Responsible for follow up on appropriate action items from meetings, serving as liaison between applicable departments; document updates and next steps.

• Manage a set of provider relationships to achieve Blue Shield of California goals in the areas of financial sustainability, Quality performance, membership growth, provider satisfaction, communication, and data integration, equating to overall programmatic success.   Responsible for understanding the day-to-day operations of each Provider group's impact on the strategic goals for all LOB. Day-to-day relationship management and ensuring continuous process improvements to meet the needs of the providers. Provide timely reporting to hold providers accountable for their performance

• Act as the primary point of contact for assigned groups, addressing the provider's holistic needs while navigating complex and matrixed internal workflows and relationships to improve assigned provider’s experience with the Plan.   

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience

• At least 10 years of Project and/or program management experience in a Health Plan or healthcare system

• 10 years of Provider Relations and/or Network Management or Health Plan Operations experience

• Proficient in Microsoft Excel, with the ability to use pivot tables, formulas, and visual functions to display data. Proficient in Microsoft Word and PowerPoint, with the ability to draft documents that will be presented externally and to executive leadership

• Demonstrated understanding of utilization and quality metrics

• Excellent oral communication and presentation skills