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Blue Shield of California · 3 weeks ago

Program Manager Clinical, Principal

California, United States

Full-time

Hybrid

Lead/Staff

10+ years exp

Blue Shield of California is a nonprofit organization focused on transforming healthcare to improve quality and affordability. The Principal Clinical Program Manager will collaborate with internal and external stakeholders to enhance healthcare delivery, ensuring best-in-class care for members while focusing on strategic execution to achieve the Quadruple Aim.

Financial ServicesHealth InsuranceNon Profit

H1B Sponsor Likely

Responsibilities

Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California’s strategic goals

Consult with all levels (including senior management) making recommendations and influencing 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

Perform data analysis for all lines of business: Analyze data in collaboration with Regional Medical Director for trends, drivers, and key initiatives. Incorporate the analysis into meaningful discussions with Group/IPA

Identify opportunities around utilization, quality, and clinical initiatives: Work side by side with internal and external partners in the design and launch of clinical programs focused on high-risk members, hospital initiatives, and behavioral health as well as internal innovation programs

Partner with medical groups to co-create programs encompassing a full spectrum of initiatives around disease management, complex care management, transitions of care and site of service, ensuring optimal utilization, access, and quality of care for members

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

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

Qualification

California RNNPPA licenseHealth plan experienceData analyticsBachelor’s degreePowerPoint skillsVerbal communicationWritten communicationCollaborationCreative solutions

Required

Requires a current, active California RN, NP, or PA license

Requires a bachelor's degree; advanced degree is preferred

Requires a minimum of 10 years of prior relevant clinical or job related experience

Requires previous health plan experience with understanding of Accountable Care Organizations (ACO), global versus shared risk financial arrangements, quality metrics and member experience. Experience in case utilization and utilization management and managed care delegated models is a plus

In-depth understanding of data analytics with mastery of excel and an ability to use multiple data platforms for internal and external communication

Strong PowerPoint application skills to create executive summaries and presentation decks

Excellent verbal and written communication style to drive positive outcomes

Ability to be resourceful and collaborative; a team collaborator with strong listening skills and the ability to offer creative solutions to drive consensus

Company

Blue Shield of California

Glassdoor3.8

Blue Shield of California is a health insurance service provider.

Founded in 1939

San Francisco, California, USA

5001-10000 employees

https://www.blueshieldca.com

H1B Sponsorship

Blue Shield of California has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (1)

2022 (41)

2021 (20)

2020 (31)