Program Manager, Principal

Blue Shield of California • El Dorado Hills, CA

3h • Hybrid

About The Position

The Enterprise Prior Authorization Accountability Program Manager will serve as the Accountable Business Driver for all enterprise-wide prior authorization initiatives. This role ensures compliance with federal and state mandates, AHIP (America’s Health Insurance Plans) commitments, and organizational governance standards while driving operational excellence and cross-functional alignment. The position reports to the Vice President, Medical Care Solutions and partners closely with Healthcare Quality and Affordability leadership, clinical teams, and technology stakeholders. In this role you will help provide strategic direction for prior authorization and drive organizational alignment balancing affordability with industry requirements across a multi-year effort and implementation.
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.

About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Responsibilities

• The Enterprise Prior Authorization Accountability Program Manager will serve as the Accountable Business Driver for all enterprise-wide prior authorization initiatives.
• This role ensures compliance with federal and state mandates, AHIP (America’s Health Insurance Plans) commitments, and organizational governance standards while driving operational excellence and cross-functional alignment.
• The position reports to the Vice President, Medical Care Solutions and partners closely with Healthcare Quality and Affordability leadership, clinical teams, and technology stakeholders.
• In this role you will help provide strategic direction for prior authorization and drive organizational alignment balancing affordability with industry requirements across a multi-year effort and implementation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed