Blue Shield of California
Program Manager Clinical, Principal
Blue Shield of California, Long Beach, California, us, 90899
JOB DESCRIPTIONYour Role
The Care Management department, which oversees all care management for the Dual Special Needs Program (DSNP) line of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of CMS Model of Care (MOC) requirements as it pertains to NCQA standards. The Clinical Program Manager, Principal will report to the Director of Care Management. In this role, you will provide oversight for the entire DSNP MOC Program and clinical programs, ensuring alignment with organizational goals and objectives.
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
Lead and manage the Model of Care steering committee and strategic initiatives related to MOC projects
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
Lead initiatives to enhance the quality, efficiency, and effectiveness of clinical programs
Assist with monitoring completion of regulatory activities
Develop a program, integrated program plan, resource plan, contingency plan, and related project management artifacts
Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
Analyze program data and metrics to identify trends, opportunities for improvement, and areas of risk
QUALIFICATIONSYour Knowledge and Experience
Requires a bachelor’s degree or equivalent experience
Requires at least 10 years of prior relevant experience
Requires excellent analytical skills, with the ability to interpret complex data and make data-driven decisions
Requires 3-5 years Care Management experience in a health plan or other managed care setting
In-depth knowledge of compliance and regulatory requirements, with specific expertise in MOC is desired
Requires exceptional communication skills, both verbal and written
Requires a valid California RN license
Pay Range:
$136,400.00 to $204,600.00 for California.
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The Care Management department, which oversees all care management for the Dual Special Needs Program (DSNP) line of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of CMS Model of Care (MOC) requirements as it pertains to NCQA standards. The Clinical Program Manager, Principal will report to the Director of Care Management. In this role, you will provide oversight for the entire DSNP MOC Program and clinical programs, ensuring alignment with organizational goals and objectives.
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
Lead and manage the Model of Care steering committee and strategic initiatives related to MOC projects
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
Lead initiatives to enhance the quality, efficiency, and effectiveness of clinical programs
Assist with monitoring completion of regulatory activities
Develop a program, integrated program plan, resource plan, contingency plan, and related project management artifacts
Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
Analyze program data and metrics to identify trends, opportunities for improvement, and areas of risk
QUALIFICATIONSYour Knowledge and Experience
Requires a bachelor’s degree or equivalent experience
Requires at least 10 years of prior relevant experience
Requires excellent analytical skills, with the ability to interpret complex data and make data-driven decisions
Requires 3-5 years Care Management experience in a health plan or other managed care setting
In-depth knowledge of compliance and regulatory requirements, with specific expertise in MOC is desired
Requires exceptional communication skills, both verbal and written
Requires a valid California RN license
Pay Range:
$136,400.00 to $204,600.00 for California.
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