Blue Shield of California · 1 day ago
Sr. Manager, Program Management Clinical
Long Beach, CA, United States
Full-time
Hybrid
Senior Level, Lead/Staff
$154K/yr - $231K/yr
10+ years expBlue Shield of California is a nonprofit organization focused on transforming healthcare to be more affordable and effective. The Sr. Manager, Clinical Quality Review, will lead the Quality Review team, ensuring compliance with regulatory standards and enhancing quality assurance processes while fostering team development and accountability.
Financial ServicesHealth InsuranceNon Profit
No H1B
Responsibilities
Lead a high-performing team by setting clear goals, providing guidance, and driving strategies aligned with organizational objectives. Foster accountability, collaboration, and continuous learning to achieve operational excellence
Ensure team compliance with best practices and regulatory requirements while developing innovative approaches to enhance quality assurance processes
Establish and monitor team goals and monthly targets. Implement streamlined reporting to track progress, identify barriers, and recommend improvements while maintaining fiscal responsibility
Perform clinical audits as needed to ensure team compliance with regulatory standards, internal policies, and quality assurance of business requirements
Identify process improvement opportunities to optimize team performance
Build strategic relationships with stakeholders to ensure successful HQA quality assurance outcomes and assess audit needs across business functions
Communicate audit finding trends to business leaders and collaborate with training facilitators to drive quality assurance and continuous improvement
Oversee annual NCQA Inter-Rater Reliability requirements, processes, and reporting
Present Quality Review Team processes and outcomes during regulatory audits and committee meetings
Ensure consistent year-over-year performance with audits meeting or exceeding targets
Coach and develop the Quality Review team, fostering growth and engagement
Qualification
Required
Requires at least 10 years of prior relevant experience including 4 years of direct people management experience
Requires a current California RN License
Strong understanding of Blue Shield of California lines of business and Health Solutions Operations as related to various regulatory (NCQA, DMHC, DHCS, CMS) and internal compliance requirements
Strategic thinking and decision-making
Proficiency in management and process improvement
Ability to manage complex projects and competing priorities
Strong communication and presentation skills
Preferred
Bachelor of Science in Nursing or advanced degree preferred
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gary Culp
Senior Vice President, Government Markets
Gregory Siebert
Senior Vice President Provider Partnerships & Network Management
Recent News
2026-01-13
Fierce Healthcare
2025-12-15
Company data provided by crunchbase