Program Manager, Principal

Your Role

The Medical Care Programs team is responsible for managing vendor-delivered programs to manage care and deliver benefits for our members. The Program Manager, Principal will report to the Senior Manager, Select Benefits and Utilization Management. You will be a member of a small team responsible for managing the vendor(s) that conduct prior authorization for oncology, advanced imaging, spine surgery, and interventional pain. You will be responsible for driving value, managing performance, and maintaining regulatory compliance.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

This role requires this person to live within 50 miles of a BSC office. Our office locations: Lodi, Redding, Rancho Cordova, El Dorado Hills, Oakland, Long Beach, San Diego, and Woodland Hills. 

This person will go into the office 8 times per month, which is 2 days per week. 

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 and implement to successful conclusion

• Be responsible for ensuring overall program and project delivery, schedule and budget attainment, and effective management of leadership expectations in achieving overall desired outcomes

• Participate in RFP's and vendor contracting

• Oversee delivery of services by vendors

• Perform, monitor and sustain compliance activities to ensure audit readiness at all times

• Be accountable for performance outcomes, particularly in reducing cost of health care and improving member and provider experience

• Monitor and research performance trends, identify issues and drive appropriate process improvement opportunities

Your Knowledge and Experience 

• Requires a college degree or equivalent experience; master’s degree preferred

• Requires 10 years of prior relevant experience 

• Health care or health plan experience required

• Project Management certification desired

• Program management or vendor management experience required

• Oncology experience preferred

• Utilization management or claims experience required

• Strong analytical, problem solving, communication, and presentation skills required