Program Manager, Consultant - CalPERS Cost of Health Care

Your Role

The Select Business Solutions team at Blue Shield of California plays a central role in managing the performance of the CalPERS PPO line of business ensuring the delivery of high-quality, affordable healthcare services to CalPERS PPO members. The Program Manager, Consultant - CalPERS Cost of Health Care will report to the Director of Select Business Solutions. In this role you will play a critical role in identifying, implementing and managing cost of health care solutions. This role ensures successful delivery of programs that support CalPERS’ goals for affordability, quality, and member experience. The Program Manager collaborates cross-functionally to manage complex workstreams, resolve issues, and drive continuous process improvement.

Your Work

In this role, you will:

• Partner with cost of health care analytics team to review data to identify impactable emerging high-cost trends and cases; Liaise with analytic and cost of health care groups across enterprise to compare trends, share knowledge, and measure outcomes
• Research and recommend interventions, identify and drive mitigation of emerging high-cost cases, geographies and trends and coordinate the execution of these action plans to significantly impact the cost of health care
• Align interventions with measurable outcomes and ensure consistent tracking of progress through defined metrics and regular reporting
• Lead cross-functional meetings and foster teamwork, drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders to support CalPERS cost of health care initiatives  
• Provide overall program leadership, guidance, and manage all aspects of the CalPERS PPO cost of health care taskforce, including data mining, reviewing findings and vetting solutions, developing metrics and targets, and reporting overall taskforce progress
• Collaborate with the Population Health Management vendor to ensure accountability for member site of care steerage, steerage to providers in alternative payment models, referrals for eligible members to available BSC resources, e.g. palliative care, diabetes prevention program
• Partner with cost of health care analytics team to review claims data to flag high-cost trends, outlier cases, and potential fraud, waste, or abuse situations for further investigation and action

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires exposure or experience with Cost of Health Care initiatives
• Requires data analytics experience and the ability to identify trends and identify insights
• Requires experience with cross-functional coordination and stakeholder engagement
• Requires proficiency with MS Excel and Access