Program Manager Clinical, Principal

Blue Shield of California • Oakland, CA

21h • Hybrid

About The Position

The Blue Shield Behavioral Health Clinical Market Engagement, Strategy and Programs team works with internal and external business and clinical partners to develop, execute, and evaluate Blue Shield of California’s behavioral health and addiction medicine strategy and ecosystem. The Principal Program Manager, Clinical supports behavioral health quality and integrated medical/behavioral health initiatives across all lines of business, owns a portfolio of work, and leads projects with internal partners for continuous quality improvement, including NCQA requirements, regulatory and mandate programming, and member and provider experience improvement.

The role operates at a strategic business level, consulting with stakeholders at all levels, including senior management, and influencing decisions. It plans and implements complex projects across business areas and quality initiatives related to mental healthcare and substance abuse services. The position represents Blue Shield Behavioral Health in relevant quality and strategy workgroups, forums, and committees, and manages regular stakeholder communications about project progress and risks.

This role reports to the Director of Behavioral Health Clinical Market Engagement, Strategy and Programs. It follows a hybrid workplace model, generally requiring employees to work in the office two days each week. Employees living more than 50 miles from an office location will coordinate in-office time with their manager based on business needs.

Requirements

• Bachelor’s degree, or a high school diploma/GED plus four years of additional relevant experience in lieu of a degree, and completion of an accredited educational program that meets the requirements for the applicable professional license.
• Unrestricted California license as an RN, PA, LCSW, LMFT, LPCC, or PsyD.
• At least 10 years of prior relevant experience, including service quality programs and/or service products, health plan operations, or equivalent.
• Behavioral healthcare experience from one or more perspectives, such as vendor, payer/plan, MBHO, clinical, provider relations, products, program evaluation, IPA or medical group, or hospital.
• Experience driving sustainable change across multiple stakeholders, focused on continuous quality improvement initiatives and strategies.

Nice To Haves

• Vendor and/or product development and management experience, including proposal development, selection, evaluation, marketing, and communications.
• Experience with integrated behavioral and medical healthcare models and practice considerations.

Responsibilities

• Ensure projects and programs align with Blue Shield of California’s strategic goals.
• Consult with stakeholders at all levels, including senior management; make recommendations and influence decision-making.
• Leverage internal and external cross-functional relationships to advance initiatives.
• Plan and implement multiple, highly complex projects and programs spanning business areas and quality improvement or management initiatives related to mental healthcare and substance abuse services.
• Identify key clinical and business issues, develop effective action plans, and implement them through successful completion.
• Design, execute, and evaluate a sustained high-performance portfolio of products across the prevention and clinical spectrum.
• Represent Blue Shield Behavioral Health in relevant quality and strategy workgroups, forums, and committees.
• Manage regular internal stakeholder communications using project and product management tools to identify progress, risks, and related updates.
• Lead continuous quality improvement activities, including work related to NCQA requirements, regulatory and mandate programming, and member and provider experience improvement.

What This Job Offers

• Job Type: Full-time
• Career Level: Principal