Program Manager, Senior

Blue Shield of California • Long Beach, CA

3d • Hybrid

About The Position

The Clinical Quality Analytics team oversees clinical quality measurement, HEDIS reporting, and related data and audit operations that support quality performance, accreditation, and regulatory requirements. Reporting to the Director of Clinical Quality Analytics, the Senior Program Manager leads the planning and execution of annual HEDIS audit operations. The role is the primary operational liaison to external HEDIS audit firms and drives timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables.

The position works with stakeholders across HEDIS reporting, Clinical Quality, data analytics, technology, compliance, and other areas to maintain audit readiness, resolve issues, and deliver commitments on schedule. It also improves repeatable audit processes, documentation controls, and cross-functional communication. The organization describes its leadership model as focused on developing leaders, creating growth opportunities, building high-performing teams, achieving results, and fostering continuous learning.

Requirements

• Bachelor’s degree, or high school diploma/GED with four additional years of relevant experience in lieu of a degree.
• At least 5 years of prior relevant program or project management experience, including ownership of complex cross-functional deliverables, milestone tracking, risk management, and stakeholder communication.
• Solid understanding of project and resource management and business acumen, with experience working in complex delivery environments.
• Strong analytical, problem-solving, organizational, written, and verbal communication skills.
• Ability to independently drive action and influence stakeholders without direct authority.
• Familiarity with enterprise project or portfolio management tools.

Nice To Haves

• Experience with HEDIS reporting and NCQA HEDIS compliance audits, particularly serving as a liaison to external HEDIS audit firms.
• Experience coordinating virtual HEDIS onsite audits, audit roadmaps, audit information requests, and secure data exchanges.
• Knowledge of health plan clinical quality operations, supplemental data source processes, and audit documentation practices.
• PMP or other relevant project management certification; not required.

Responsibilities

• Lead planning and execution of annual virtual HEDIS onsite audits, including agendas, scheduling, participant preparation, evidence coordination, meeting facilitation, action-item tracking, and timely closure of follow-up requests.
• Serve as the primary operational point of contact for external HEDIS audit firms; coordinate secure data and documentation exchanges, clarify requests, establish response owners, and monitor submission quality and timeliness.
• Own coordination and completion of the annual HEDIS audit roadmap and integrated workplan, including milestones, accountable owners, dependencies, decision points, and escalation procedures.
• Partner with HEDIS reporting, Clinical Quality, data analytics, technology, compliance, and other stakeholders to maintain audit readiness, resolve issues, and deliver commitments on schedule.
• Coordinate supplemental data source submissions and audit support activities, including communications with internal and external submitters, documentation collection, and tracking validation and evidence requests.
• Maintain audit status, deliverable, risk, and issue tracking; provide leadership updates, recommend corrective actions, and proactively escalate barriers requiring decisions.
• Improve repeatable audit processes, templates, documentation controls, and cross-functional communication to strengthen readiness and reduce avoidable rework.
• Perform other duties as assigned.

What This Job Offers

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