Program Manager, Principal - Portfolio Management

Your Role 

The Portfolio Management team is responsible for supporting all HQA functional areas to meet their strategic and tactical goals. The Principal Program Manager will report to the Senior Director, Portfolio Management. In this role you will lead complex strategic healthcare initiatives focusing on improving healthcare quality, affordability, and member satisfaction. Key duties include complex program and process planning, implementation, and maintenance, operational process analysis, and medical policy review and maintenance.

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.

Your Work 

In this role, you will: 

• Operate at a strategic business level to ensures 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
• Develop and maintain data driven strategy and operational reporting process in support of the Blue Shield prior authorization function.  Analyze data, build control reporting, and communicate changes to all levels of the BSC enterprise
• Use data to assess operational performance, identify trends, and guide decision-making
• Drive initiatives that lead to better clinical outcomes, cost reduction, and member/provider satisfaction
• Contribute to HQA artificial intelligence strategy and make recommendations on areas of potential implementation
• Support evolving HQA portfolio and vendor strategy

Your Knowledge and Experience 

• Requires a bachelor's degree or equivalent experience
• Requires at least 10 years of prior relevant experience
• Requires a minimum of 8 years of demonstrated experience in healthcare operations working for a managed care organization
• Requires a minimum of 5 years of intermediate to advanced experience with program and project management
• Requires intermediate to advanced experience with SQL and MS Excel
• Experience with healthcare regulatory research and interpretation preferred
• Experience with healthcare code sets (CPT/HCPCS/ICD/DRG, etc.) preferred