Sr. Manager, Program and Project Management

Your Role

The Quality Improvement and Provider & Plan Quality Incentives (PPQI) teams strive to improve the health outcomes of our members. We strategize, plan and execute programs that support provider efforts to get patients into preventive care. We work with a broad spectrum of both internal and external stakeholders to develop programs that are directly aligned to national standards for high-quality healthcare.

The Senior Manager, Provider & Plan Quality Incentives will report to the Director, Quality Management. In this role you will provide people leadership and guidance to a team of Program Managers and Business Analysts at various levels. You will guide and consult on complex analytical deliverables produced by the Provider & Plan Quality Incentives (PPQI) team, including but not limited to payout modeling, forecasting, calculation and program evaluation. You will bridge both performance and cost views across targeted populations including Commercial HMO, Covered CA HMO, Covered CA PPO, Medicare and Medi-Cal. You will support the improvement of our work and our positive impact on both providers and members.

The Senior Manager is also responsible for fostering partnerships across the organization, for all levels of the Blue Shield cohort within which we work. In the role, you will have the opportunity to build and grow peer relationships and have the opportunity to work with or provide information to our most senior leaders. This work may include but is not limited to strategizing effective meetings for senior leadership, launching annual revenue summaries to internal stakeholders, collaborating with Directors across the Quality team to uphold their performance improvement strategies, and connect with subject matter experts to get to accurate information to the right places. 

The Senior Manager, Provider & Plan Quality Incentives is a critical member of the Quality team, supporting multi-million dollar annual operations, with programs that touch thousands of provider and member lives. 

Your Work

In this role, you will:

• Provide people management in a complex environment, centering Blue Shield’s leadership model and values
• Lead strategic planning initiatives that support Quality’s overall performance goals while managing regulatory requirements
• Provide analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Develop budgets and forecasts for existing programs; build business cases for new initiatives (cost/benefit analysis)
• Define business requirements and provide analysis of operational efficiency 
• Work cross-functionally in analyzing, designing and launching business solutions
• Develop, prepare, and analyze reports with complex analysis and data for management review
• Provide analytical support for complex cross-functional projects, coordinate with internal and external resources 

Your Knowledge and Experience

• Requires a bachelor’s degree; master’s degree in public health, business administration, healthcare administration or related field strongly preferred 
• Requires a minimum of 5 years of people management experience 
• Requires a minimum of 7-10 years of health plan or healthcare industry experience, with at least 2 years of Quality experience specific to the Healthcare Effectiveness Data and Information Set (HEDIS); experience and familiarity with DHCS, DMHC and CMS regulations strongly preferred 
• Requires experience in working cross-functionally in analyzing, designing, and developing business solutions 
• Requires excellent verbal and written communication skills and the ability to interact professionally with a diverse group of executives, managers, and subject matter experts as well as external customers
• Strong problem solver with demonstrated ability to identify root cause of low complexity issues
• Able to function independently and produce results that meet standards of quality, timeliness, and acceptability
• Ability to navigate a hybrid or remote work environment while building and maintaining effective team collaboration and performance 
• Requires advanced skills in Microsoft Excel, Word, Visio, and PowerPoint in preparing and making presentations to various levels of management 
• Prior experience in SQL preferred