Program Manager Clinical, Consultant (Case Notes)

Blue Shield of California • Long Beach, CA

4d • Hybrid

About The Position

The Commercial CMO Team provides clinical oversight for programs and processes that support members’ health care, reduce costs, and improve quality. The Program Manager Clinical, Consultant reports to the Director of Program Management, Clinical – CMO. In this role, you will analyze clinical and financial data to identify trends and opportunities to improve care and manage costs for employer-funded health insurance. Leading projects to address these opportunities and develop presentations that clearly communicate the clinical insights and recommended actions. You will also facilitate meetings with internal and external stakeholders and drive improvements in healthcare cost trends through both direct interventions and broader, system-level initiatives. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires current California LVN, RN, NP, or PA license
• Strong organizational and/or project management skills, consistent ability to “self-start” and take ownership of end-to-end taskforce activities
• Excellent written and oral communication skills, ability to facilitate cross-functional discussions, lead teams through influence to drive actions and outcomes

Nice To Haves

• Prefers familiarity with health care data and the health care delivery system in California; health plan or provider experience strongly desired
• Experience in cost of health care analysis, population health outcomes, and/or program evaluation desired

Responsibilities

• Own and manage the intake process and queue for patient information summary requests, ensuring requests are prioritized, tracked, and completed in a self-directed manner.
• Collate clinical data accurately from multiple systems and sources, synthesizing relevant information into a cohesive clinical story for use in clinical rounds, stakeholder discussions, and related business needs.
• Prepare clinical summaries that may be presented directly or used by clinical leaders and cross-functional partners to support decision-making, care coordination, and issue resolution.
• Use multiple software systems and quickly build proficiency in new platforms, including Excel and PowerPoint, to support analysis, documentation, reporting, and presentation development.
• Maintain a strong focus on patient privacy, confidentiality, and appropriate handling of sensitive clinical information.
• Apply an understanding of client needs and business context to ensure clinical summaries are accurate, relevant, and appropriately tailored for the intended audience.
• Identify opportunities to support additional project, process improvement, or strategic work related to clinical findings, case summary trends, and themes emerging from clinical rounds.

What This Job Offers

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