Program Manager Clinical, Principal (Registered Nurse/Nurse Practitioner/Physici at Blue Shield of CA in San Diego, California

Job Description:

The Senior Clinical Program Manager in collaboration with the Regional Medical Director and internal Blue Shield of California teams will be responsible for collaborating with all externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction) with a focus on execution to drive and accelerate improvements in primary care for all patients. This role will report to the Regional Medical Director.

Specific Responsibilities Include:

Setting goals, providing direction and supporting implementation of clinical initiatives with strategic partners to include:

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Evaluate data in collaboration with Regional Medical Director for trends, drivers and key initiatives. Data will be incorporated into meaningful discussions with Group/IPA and be presented in tandem with the larger team.

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Work alongside partners in external environment to help implement improved processes including but not limited to:

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Assist in the evaluation and identification of opportunities around utilization, quality, and clinical initiatives. This may require working side by side with external partners in the design and launch of clinical programs focused on high risk members, hospital initiatives, behavioral health as well as internal innovation programs

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Ensure access to preventative care services and high quality to reach contract specific and internal goals.

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Partner with medical groups to help create or redesign care programs focused on ensuring access to care, optimal inpatient utilization and access to urgent/emergent care.

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Bring care to members who might otherwise be hospitalized or unable to access care. Ensure palliative care programs are available where appropriate and when needed.

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Co-create Care Management programs encompassing a full spectrum of initiatives around disease management, complex care management, transitions of care and multidisciplinary rounding. Work with partners to provide guidance and rapid cycle process improvement of programs.

Responsible for strategic alignment and clinical integration across all lines of business and other innovative value-based care model projects/programs in collaboration with Regional Medical Director including but not limited to:

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Responsible for day to day process analysis, and data analysis of all lines of business and innovative value-based care models to support affordability

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Partner with internal and external teams to transformation organizations into high efficiency/high quality health organizations

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Lead with a collaborative approach and an understanding of existing resources and relationships between/among partner organizations while moving them towards constructive change

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Works cross functionally with Blue Shield of California internal teams to provide support both ad hoc and recurrent on initiatives

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Influence and collaborate with hospital and physician groups

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Influence and participate in process change and implementation

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Participate in the development, design and launch of innovative care models

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Exercises judgment in developing methods, techniques and evaluation criteria for obtaining results

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Provide input into designing strategies for alignment with business unit goals objectives

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Other duties as assigned.

Qualifications:

- Current, active California RN, NP or PA license

- Experience in a clinical health care clinic or home care program highly preferred

- Experience in case utilization, quality improvement & disease management

- In-depth understanding the managed care delegated model and associated efficiency and quality measures

- Proven ability to develop effective action plans and implement to successful conclusion

- Ability to interact with all levels including senior management and influence decision-making.

- Health plan experience preferred.

Job Additional Experience/Leadership Core Competencies

Conflict resolution skills, and change management skills with the ability to work with and meet deadlines

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Expert ability to follow up and follow through on all tasks, attention to detail and accuracy is required.

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Able to synthesize and collate information from various sources, create reports and presentations at Management level.

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Ability to multi-task and work closely with all associated in the delivery of services

Establishes high standards for self and others and knows how to positively motivate internal and external stakeholders to achieve those same standards.

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Demonstrates tenacity and resourcefulness in seeking creative solutions to challenges

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Able to anticipate change and respond with a trusting and collaborative approach.

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Is objective, a good listener and partner in problem-solving and reaching consensus.

Considered a trusted team member and co-worker, takes responsibilities seriously and delivers as promised.

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Effectiveness in communication style (written and verbal), with advanced grammar comprehension, and proven ability to positively influence behavior toward a positive outcome

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Preparation of reports, graphs, and presentations, conducting research and illustrating data using spreadsheet, database and graphic software; must be internet literate.

These positions can be located at Blue Shield of California offices in Ontario, Monterey Park, Woodland Hills, Costa Mesa or San Diego and will require statewide travel to Northern and Southern California locations.

Additional Information

- Our Company: 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!

- Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

- Equal Employment Opportunity: 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.

- Requisition ID: 20002F8

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