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Program Manager, Consultant

Company: Blue Shield of California
Location: Woodland Hills
Posted on: September 22, 2023

Job Description:

Your Role The Medi-Cal Quality Improvement team is responsible for supporting our contracted providers with improving quality outcomes for the Medi-Cal population through education, intervention design, and collaboration. The Program Manager, Consultant will report to the Sr Manager of Quality Improvement. In this role you will support the quality improvement team and our partnering providers by analyzing quality data, identifying opportunities for improvement, and outlining and implementing plans to reach our HEDIS goals. Your Work In this role, you will:

  • Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation
  • Provide steady leadership in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model
  • 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
  • Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
  • Review medical records to identify missing data elements to capture HEDIS numerator compliance
  • Exhibit ability to understand EMR functionality for HEDIS compliance across multiple HEDIS domains
  • Recognize internal and external operational opportunities to optimize HEDIS performance and demonstrate the ability to work well with others to accomplish goals in a timely manner At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in , Join us!Your Knowledge and Experience
    • Requires at least 7 years of prior relevant experience
    • Requires a bachelor's degree or equivalent experience
    • Understanding of HEDIS requirements pertaining to documentation and coding
    • Understanding of the Medi-Cal Market and has FQHC relationship experience and/or experience in an IPA/Medical Group setting
    • Project Management skills that can be used to manage multiple relationships and projects
    • Able to support with timely resolution of complex claims, benefit, enrollment, data, and other issues
    • Comfortability leading training sessions, coordination, and facilitation of focused activities Pay Range: The pay range for this role is: $ 109120.00 to $ 163680.00 for California. Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

Keywords: Blue Shield of California, Los Angeles , Program Manager, Consultant, Executive , Woodland Hills, California

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