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Program Manager, Clinical Quality at Blue Shield of CA in El Segundo, California

Posted in Other 30+ days ago.

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Type: Full Time





Job Description:

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone. Job Summary:
Under direction, the Program Manager is responsible for managing one or more mid-size to complex projects to support the Clinical Quality Program. The Program Manager is required to lead assigned projects while maintaining all project management information including timelines, resources, issues, scope, and other related project activities. This position works closely with the Director and key stakeholders to achieve and sustain a higher performance in Clinical Quality Ratings related to Medicare and Cal-Medi-Connect.

Scope & Responsibilities:

* Tracks and manages policy changes to the Cal-Medi-Connect and Medicare Star program and keeps executive sponsors and key stakeholders well-informed of the changes and impact. Also, responsible for working with key stakeholders to execute on action plans that comply with new changes. Acting liaison and subject matter expert on CMS communications.

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Tracks and manages key stakeholder performance to goals and holds them accountable to improved performance.
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Collaborate with key stakeholders to identify gaps, barriers and opportunities for improvement, and develop and implement enhancements that align with our Critical Few goals and glide path high performance.
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Creates and manages cross-functional work plans to communicate and track timelines and deliverables.
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Responsible for the planning, design, and management of various cross-functional projects aimed at improving Medicare Star performance.
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Ensures project goals and objectives are accomplished within designated timeframes and budget constraints. Also, regularly informs executive sponsors and key stakeholders of project status.
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Executes project activities in accordance with established schedules, milestones, and processes to ensure that all projects are well scoped, well documented, and completed on time.
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Reports significant issues, accompanied by proposed solutions, in a timely manner to leadership.
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Prepares presentation material for executive level viewing.
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Trains and mentors department coordinators and administrative staff to assist in project management, if appropriate.
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Knowledge of company products, functions, marketing and/or service policies and procedures.
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Serve as a quality expert with internal constituents to drive Star-related program development and outcomes success.
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Educate and work with external partners and participating practices as needed to identify innovation opportunities and adopt Star-related improvement actions.
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Some travel is required.
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Assists in other duties as assigned.

Nature of Supervision:

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This position does not have direct reports but provides indirect oversight of department coordinators and administrative staff to assist in project management.
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May provide guidance and supervision to project consultants.
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Ensures various project team members provide high quality work products in a timely manner.
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Influences staff, peers, and leaders functioning in a matrix environment.

Key qualifications to include:

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High Integrity/Ethics/Trust
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Strong ability to drive for results
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Strong facilitator with demonstrated excellence in driving multi-disciplinary and cross-functional teams to consensus
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Demonstrated ability to influence in a healthcare environment
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Seasoned Critical Thinking
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Ability to manage large, complex projects
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Communication the ability to summarize complex information succinctly, using QI methodology as a guide
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Experienced in Change Management Processes, including Improvements and Redesign
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Skilled at facilitating and growing Collaboration and Motivation amongst geographically disperse teams
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Strong Interpersonal skills and demonstrated ability to build relationships in fast-paced environments
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Financial/Quantitative acumen

Job Summary:
Under direction, the Program Manager is responsible for managing one or more mid-size to complex projects to support the Clinical Quality Program. The Program Manager is required to lead assigned projects while maintaining all project management information including timelines, resources, issues, scope, and other related project activities. This position works closely with the Director and key stakeholders to achieve and sustain a higher performance in Clinical Quality Ratings related to Medicare and Cal-Medi-Connect.

Scope & Responsibilities:

* Tracks and manages policy changes to the Cal-Medi-Connect and Medicare Star program and keeps executive sponsors and key stakeholders well-informed of the changes and impact. Also, responsible for working with key stakeholders to execute on action plans that comply with new changes. Acting liaison and subject matter expert on CMS communications.

*

Tracks and manages key stakeholder performance to goals and holds them accountable to improved performance.
*

Collaborate with key stakeholders to identify gaps, barriers and opportunities for improvement, and develop and implement enhancements that align with our Critical Few goals and glide path high performance.
*

Creates and manages cross-functional work plans to communicate and track timelines and deliverables.
*

Responsible for the planning, design, and management of various cross-functional projects aimed at improving Medicare Star performance.
*

Ensures project goals and objectives are accomplished within designated timeframes and budget constraints. Also, regularly informs executive sponsors and key stakeholders of project status.
*

Executes project activities in accordance with established schedules, milestones, and processes to ensure that all projects are well scoped, well documented, and completed on time.
*

Reports significant issues, accompanied by proposed solutions, in a timely manner to leadership.
*

Prepares presentation material for executive level viewing.
*

Trains and mentors department coordinators and administrative staff to assist in project management, if appropriate.
*

Knowledge of company products, functions, marketing and/or service policies and procedures.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.