Program Manager, Senior

Program Manager, Senior

Your Role

The Quality Improvement Team is accountable for quality ratings of the organization and the development and execution of targeted, quality improvement initiatives in support of the commercial medical groups, hospitals, affiliated providers, and our Covered California membership. The Program Manager, Senior will report to the Senior Manager, Quality Improvement for the Medi-Cal population in Los Angeles County. In this role you will be responsible in the Medi-Cal line of business for the development and execution of targeted, quality improvement initiatives with our external provider group partners to achieve improved outcomes in HEDIS measures. You will partner with other lines of business and align quality interventions to the organizational strategies for HEDIS, QRS, CAHPS, and our Covered California membership. The Program Manager, Senior will manage to data driven outcomes and targets helping to facilitate getting provider data into our Blue Shield systems.

Your Work

In this role, you will:

• Manage external request and coordinate responses to internal business owners
• Review contracts related to plan quality incentives and auto-assignments for any changes and impact to teams
• Manages all executive-level and summary content requests for auto-assignment and VIIP including presenting to leadership
• LA Care VIIP and Auto-assignment tracking, forecasting, education, and reporting
• Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
• Manage to major operational program milestones (e.g., IPA Action Plans)
• Manage stakeholders involved in performance improvement initiatives
• Manage or partner to manage domain-specific forums, Member Experience workgroup, UM partnership, and Encounters
• Create plan to implement new mandates from DHCS and LA Care
• Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation
• Provide steady leadership in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model
• Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
• Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives
• Exhibit ability to understand EMR functionality for HEDIS compliance across multiple HEDIS domains
• Recognize internal and external operational opportunities to optimize HEDIS performance and demonstrate the ability to work well with others to accomplish goals in a timely manner

Your Knowledge and Experience

• Requires a bachelors degree or equivalent experience
• Requires at least 5 years of progressive program management experience developing interventions to improve HEDIS rates within the Medicaid or Medi-Cal population
• Requires previous experience in quality improvement and process/performance improvement for the Medicaid line of business, in an outpatient healthcare setting
• Requires solid facilitation skills with demonstrated excellence in driving multi-disciplinary and cross-functional teams to consensus
• Highly adept computer skills; demonstrate mastery of the following MS Office products: Outlook, Excel, PowerPoint, Visio, and Word (must be able to manage complex scheduling in Outlook; apply conditional formatting, create pivot tables, utilize index and match, nested Ifs, and simple macros in Excel; slide design, utilize transition effects, and embed files in PowerPoint; create flow charts in Visio; and excellent page formatting, mail merge in Word)
• Proficient knowledge of HEDIS and CAHPS requirements for Medicaid or Medi-Cal health plans in Los Angeles County required
• Requires ability to attend clinic day events in Southern California in-person
  • Must be able to lift 25 pounds, transport large items, assemble and disassemble office furniture, stand and sit for long periods at a time

Pay Range:

The pay range for this role is: $ 85360.00 to $ 128040.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.