Job Description

Your Role

The Population Health Management (PHM) team promotes a vision and strategy to drive differentiation in member experience and engagement, improvement in the overall health of Blue Shield of California members, and affordability and efficiency in the healthcare system. The Program Manager Clinical, Principal will report to the Director of Social Services Management, PHM. In this role you will ensure compliance of NCQA and DHCS PHM requirements.

Your Work

In this role, you will:

• Operate at a strategic business level to ensures 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 business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Assist in monitoring compliance of regulatory activities
• Present Social Services, Social Programs & PHM data and outcomes to executive leadership
• Lead with a collaborative approach and an understanding of existing resources and relationship between/among partner organizations while moving them towards constructive change

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We\'re excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area\'s top companies in volunteering & giving, and one of the world\'s most ethical companies. Here at Blue Shield of California, we\'re striving to make a positive change across our industry and the communities we live in , Join us!

Your Knowledge and Experience

• Requires a Master\'s degree in a Social Work or equivalent field
• Requires at least 10 years of prior relevant experience
• Requires current, active California Board of Behavioral Sciences (BBS) license: LCSW, LMFT, LPCC
• Knowledge of Medi-Cal (Medicaid) benefits and applicable resources
• 3-5 years Care Management experience in a health plan or other managed care setting
• Excellent verbal and written communication style, coupled with strong data analytics skills, to drive positive outcomes
• Resourceful and collaborative: team collaborator with strong listening skills and the ability to offer creative solutions to drive consensus

Pay Range:

The pay range for this role is: $ 136400.00 to $ 204600.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate\'s experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

Blue Shield of California