Program Manager, Principal

Blue Shield of California•Oakland, CA

1d•Hybrid

About The Position

Your Role The Clinical Quality [Commercial Populations] team is accountable for the quality ratings achieved for the organization’s Commercial populations, as well as the preventive care strategy and outcomes for Blue Shield of California’s Commercial members. Clinical Quality also manages financial, multi-site, system, and transitions of care risks associated with Quality performance. The Program Manager, Principal (Behavioral Health Preventive Care Outcomes) will report to the Sr. Manager/Director of Clinical Quality. In this role you will create and drive the improvement strategy for preventive care outcomes in behavioral health, with a focus on multi-site care, transitions of care, and emerging HEDIS measures of mental health. Additionally, in close partnership with department leadership, you will develop and implement the operational roadmap for care gap closure through data system improvements, member support interventions, or provider engagement strategies, including but not limited to education, support and remediation activities. Specifically, the role leads annual planning for quality/improvement/equity activities and negotiates resources, workplans and timelines to achieve HEDIS and CAHPS results, as well as state contract requirements related to depression screening, follow up care after emergency room and hospital utilization, and equitable health outcomes. The role is accountable for refreshing, executing and evaluating annual plans and strategies that cascade and scale to multiple teams and functions. 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. This position requires an in-office presence two days per week (eight days per month). The office location options for this role are Oakland, Long Beach, Woodland Hills or Rancho Cordova.

Requirements

Requires a bachelor’s degree or equivalent experience
Requires a minimum of 10 years of prior relevant experience
Requires demonstrated knowledge of Quality Ratings Systems, including HEDIS, hospital, emergency room, behavioral health and CAHPS measurement
Requires a minimum of 7 years of demonstrated experience in behavioral health systems, workflows and teams
Requires experience executing improvement initiatives within or with a California based healthplan as well as experience executing member or provider engagement interventions in support of preventive care outcomes and improvement for a diverse member population
Requires demonstrated experience with annual financial modeling and operational planning in environments of rapid execution as well as demonstrated knowledge of strategic planning and multi-year project and program management
Requires demonstrated ability to communicate complex ideas simply and succinctly both verbally and in writing, including ability to speak comfortably and extemporaneously to diverse audiences, capable of self-management and exhibits a self-starter attitude as well as demonstrated experience and strong skills assembling presentations for executive audiences, including guiding teams to gather pertinent information, and navigating a variety of presentation formats for various audiences

Responsibilities

Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California strategic goals
Consult with all levels including senior management, make recommendations, and influence decision-making
Leverage cross-functional internal and external relationships to drive initiatives forward
Plan and implement multiple and extremely complex projects/programs spanning across businesses
Work collaboratively with teams to develop and implement quality targets and assist monitoring and collecting quality measures
Determine key business issues, develop effective action plans and implement to successful quality outcomes conclusions
Be responsible for planning and implementation of cross-functional quality improvement programs aimed at improving preventive mental health care, which will encompass multiple projects, initiatives, functions and specialties and include the evaluation/analysis of complex data, financial inputs as well as intangible variance factors
Coordinate and oversee the delivery of ambitious targets across multiple internal and external project teams of 5 to 10 people, creating structure to coordinate parallel tracks of work and information for rapid decision making
Drive care gap closure and health outcomes in behavioral health sites of care and primary care through Clinical Quality units to maximize improvement and goal achievement
Assist with budget planning as part of the annual budget cycle
Create and execute annual strategies and execution cycles for new and ongoing member interventions in collaboration with internal and external teams and Leadership