Program Manager, Consultant

Your Role

The Medicare Star Performance team is responsible for achieving sustainable Medicare Advantage and 4 Star performance. The Program Manager, Consultant – Member Experience will report to the Director of Medicare Star Strategy and Performance. In this role you will implement programs and processes designed to improve member experience within our Medicare Advantage delivery systems. You will also be responsible for leading market initiatives to address member perceptions and enhance Blue Shield of California performance on Consumer Assessment of Healthcare Providers and systems (CAHPS) and Health Outcomes Survey (HOS). This is a field-based position and will require visits with assigned delivery systems in person.

Your Work

In this role, you will:

• Actively engage leadership and staff at all levels within a provider group/medical practice setting to enhance the member experience
• Influence the development and implementation of programs that improve member experience
• Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities. Develop and deliver training programs within provider groups to increase awareness of behaviors and techniques that affect member experience
• Review program budget variance and scope change requests, and participate in the budget-resolution process  
• Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders   
• Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives  
• Identify best practices for achieving high performance on Consumer Assessment of Healthcare Providers and systems (CAHPS) and Health Outcomes Survey (HOS) measures, meeting provider groups/medical clinics where they are in their member experience journey; Collaborate with providers to create actionable strategies and process improvement plans targeting specific performance metrics
• Utilize and integrate CAHPS, HOS, and other predictive analytic data to assist organizations in improving performance and lead special projects and activities focused on CAHPS and HOS performance improvement
• Maintain awareness of industry regulations that impact CAHPS/HOS survey measures and incorporate them into strategic initiatives
• Analyze and interpret survey data to identify trends, solve complex challenges, and develop strategic plans in collaboration with provider groups to drive process improvements

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires 3+ years of experience in healthcare quality improvement, provider engagement, or Medicare Advantage performance initiatives
• Requires familiarity with CMS regulations and Medicare Advantage programs
• Requires a proven track record of leading successful provider engagement and member experience initiatives
• Requires experience in facilitating peer-to-peer learning opportunities among providers to drive innovation and continuous improvement
• Requires expertise in data and analytics: applying survey data (CAHPS, HOS, NPS) to drive performance improvement

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.