Program Manager Clinical, Senior

Program Manager Clinical, Senior

Your Role

The Medicare Stars Program team is accountable for leading the strategy to improve performance on the Medicare Star HEDIS measures. The Clinical Program Manager will report to the Operational Program Manager. In this role, you will administer clinical care to patients (in-home) identified by the health care organization, provide education to patients and/or families about preventive care, medical issues, and use of prescribed medical treatments, and responsible in completing documentation for after visits.

Your Work

In this role, you will:

• Conduct telephonic outreach to PCPs/Provider Office to request medical records or most up to date screening information for members
• Assist in medical record review for HEDIS measure review and abstraction
• Collaborate with PCPs/office staff/healthcare providers to ensure the scheduling and completion of members care such as appointments, authorization requests, lab requests, and more
• Provide weekly (or bi-weekly) tracking on member outreach status/appointments and other related activities
• Assist in ordering in-home testing kits for members
• Direct small-scale, complex programs/projects that may involve multiple internal and external stakeholders
• Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
• Develop the program, integrated program plan, resource plan, contingency plan, and related project management artifacts
• Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
• Administer Clinical Care to patients (in-home) identified by the health care organization
• Collect vital information from patients, explaining prescriptions, conduct health screenings, provide point of care testing
• Responsible for assisting administrative staff in uploading patients files into a digital database
• Conduct telephonic outreach to members about preventive care and screenings
• Other duties as assigned

Your Knowledge and Experience

• Requires a bachelors degree or equivalent experience
• Requires at least 5 years of prior relevant patient/member-facing, clinical experience
• Requires LVN Certification/License
• Requires valid CA Drivers License
• Experience and knowledge of HEDIS quality measures strongly preferred
• Strong professional level of knowledge including clinical assessment skills in the adult population and chronic disease management
• Ability to multi-task / work independently and be self-motivated to meet deadlines and achieve goals
• Ability to adjust or recommend enhancements in systems and processes to solve problems or improve effectiveness of job area
• Proficient knowledge of Microsoft Office (Excel, PowerPoint)

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.