Job Description

:

Your Role

The Program Manager, Consultant, will report to the Senior Manager of Population Health Management (PHM), Governance. In this role you will spearhead initiatives aimed at achieving and maintaining year-round compliance and regulatory readiness, partner with operational leaders to implement programs/initiatives that cross-functionally impact outcomes and ensure that the strategic initiatives meet quality standards set by the Population Health Management leadership team. Under the State mandate of the California Advancing and innovating Medi-Cal (CalAIM) Program, PHM is designed to proactively assess and address the care needs of beneficiaries with tailored interventions. Establishing a unified, statewide approach to PHM ensures that all members - children, their parents, pregnant persons, elderly and other adults, and people with disabilities - have access to a whole-system, person-centered program that leads to longer, healthier lives, improved clinical outcomes and a reduction in disparities.

Your Work

In this role, you will:

• Spearhead medium to large sized complex projects, programs, and/or initiatives, spanning across business areas
• Help maintain a Medi-Cal clinical audit readiness monitoring program that includes monitoring audit schedule, analysis of compliance monitoring reports, and directing the self-monitoring activities performed by operational departments
• Develop readiness tools and documents that are aligned with key regulatory expectations such as the DHCS (Department of Health Care Services) Technical Assistance Guide
• Provide year-round audit readiness support to cross-functional departments who have a direct/dotted line to the CMO Office
• Implement strategic initiatives identified as part of the CalAIM (California Advancing and Innovating Medi-Cal)/Population Health Management (PHM) body of work
• Identify and monitor key internal/external facing metrics and KPIs (key performance indicators) that help measure the overall efficacy on the PHM Program
• Work collaboratively and cross-functionally with internal and external partners and stakeholders to align with business priorities and drive initiative development; meeting timeline, targets, including regulatory and contractual requirements
• Operate at a strategic business level to ensure projects/programs are in line with Office of the Promise CMO strategic goals and work is sustainable over time
• Consult with all levels including senior management; develop executive communications highlighting recommendations and influence decision-making
• Manage regular internal stakeholder communications through project management tools that identify progress, risks, etc.
• Proactively identify issues, risks and/or barriers to program success and project execution and work with the appropriate teams to develop mitigation strategies and problem solve, and escalating appropriately
• Act as a thought-partner in developing a Project/Program Management governance model that can be deployed broadly and includes financial, people, process, and technology assessments.

About the Team:

Blue Shield of California\'s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. 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 fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California\'s top companies in volunteering and giving. 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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• 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:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That\'s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid - In a business unit approved office a few times per year to 3 days per week, on average

• Office - In a business unit approved office 4+ days a week, on average. If the role you\'re applying for is deemed an \xe2\x80\x9cEssential Role,\xe2\x80\x9d the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Blue Shield of California