Blue Shield of California · 8 hours ago
Clinical Account Manager, Consultant - Commercial
California, United States
Full-time
Hybrid
Senior Level
7+ years expBlue Shield of California is a nonprofit organization focused on transforming healthcare to be more affordable and effective. The Program Manager Clinical Consultant will oversee clinical program management for premier accounts, collaborating with various teams to ensure alignment with strategic objectives and enhance client interactions.
Financial ServicesHealth InsuranceNon Profit
Responsibilities
Provide clinical leadership and analysis for assigned projects/programs; ensure projects/programs meet BSC strategic objectives and contract requirements
Lead in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model
Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities
Proactively set and manage expectations to prioritize delivery and requirements, yielding consistent results
Support and provide technical expertise in planning, execution, and leadership of programs, projects, and initiatives
Provide program reporting and status to Commercial CMO or designee
Advise on access to care, letters of agreement, provider contracts, network gaps, denials, appeals and grievances, DMHC complaints, executive requests, reimbursement requests, accounts management and broker questions
Collaborate with analytics, actuarial, and quality teams to develop, analyze, and distribute reports, and document program activities, interventions, and outcomes
Perform deep-dive analysis of high-cost claims, vendor-identified population and other defined groups, producing case studies, reports and presentations
Organize and lead cross-functional meetings, foster teamwork and collaborative problem-solving across diverse stakeholders
Facilitate cost-of-care taskforces and recommend interventions at both macro and micro levels. Research industry best practices and care guidelines to support team initiatives and policy development
Provide insights into leading practices across BSC processes including medical policy, formulary, and care redirection/repatriation
Develop and maintain project plans, KPIs, stakeholder maps, and documentation to support team goals and initiatives
Maintain a repository and an extensive working knowledge of relevant client-specific documents
Support RFP responses, audits, presentations, and maintenance of program materials
Qualification
Required
Requires a bachelor's degree or equivalent experience
Requires at least 7 years of prior relevant experience
Valid CA license in a clinical discipline such as RN, LVN, NP, PA, MSW, CPhT
Exceptional communication and presentation skills
Ability to synthesize clinical data into a concise story
Ability to think outside of the box and quickly problem solve
Excellent analytical skills
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
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)
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
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