Sr. Manager, Program Development & Operations - Provider Performance Enablement

Your Role

The Senior Manager, Program Development and Operations, Provider Performance Enablement provides oversight and direction for the strategy, design, development, and implementation of solutions to support provider and health systems performance enablement. The Senior Manager reports to the Director, Program Development and Operations, Provider Performance Enablement. In this role, you will work with the Director and other Blue Shield of California (BSC) business leaders to identify issues and design, develop, and implement the strategy for all work within the Provider Performance teams (to improve provider performance across BSC). This role strategically sources and identifies internal and external partners to implement the goals and objectives of the Provider Performance Enablement teams. Additionally, this role interfaces across the enterprise, working with Program Managers, Senior Managers, Directors, Senior Directors and Vice President leaders across Healthcare Quality & Affordability, Information Technology, Finance, Actuary, Transformation & Operations, and Portfolio Management Office. Communicating with BSC and external vendor senior leadership, interfacing, and collaborating directly with providers, hospitals, health systems, and other stakeholders is critical.

The Senior Manager leads identification and mitigation of risks, conducts data analysis to measure program effectiveness, and prepares comprehensive reports for key stakeholders. They contribute to process optimization and the development of best practices, while also conducting implementation study to examine factors influencing the adoption and implementation of evidence-based interventions.

The Senior Manager leads the assessment of organizational readiness, provides consultation and training to enhance implementation competence, and engages with diverse stakeholders to ensure the relevance and feasibility of implementation efforts. Monitoring and evaluation, dissemination of findings, and staying informed of current literature and advancements in implementation science are also crucial aspects of this role.

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. 

Your Work

In This Role, You Will:

• Lead and develop the core operational model and timeline for the implementation of all work supporting the department's success metrics including monitoring and results reporting
• Collaborate with stakeholders to define initiative objectives, scope, and success criteria
• Define and track key performance indicators (KPIs) to measure the effectiveness and impact of initiatives
• Lead the development of detailed project plans, timelines, and resource allocation strategies.
• Conduct organizational assessments to identify barriers and facilitators to implementation, including organizational culture, leadership support, resources, and system-level factors
• Lead the creation of successful metrics for the Provider Performance Enablement (PPE) department and teams, informed by internal SME's/stakeholders and external (providers) in the required areas of focus - quality, affordability, risk adjustment, utilization management, and operations
• Design, develop and maintain all programs, resources and tools supporting the core work of the PPE department
• Support the implementation, timeline, and on-going assessment/evaluation plan for the Provider Engagement Strategy
• Support and lead the identification of areas for BSC organizational process change and oversee change implementation as required through feedback from SMEs/stakeholders and external providers to increase BSC organizational efficiency and provider trust
• Support and lead research to identify new tools and programs to support provider enablement
• Support and lead the development of business requirements to build new tools and programs in support of provider performance enablement in partnership leveraging HQA performance capabilities
• Implement new tools to support performance enablement (i.e. Provider adoption)
• Provide support and oversight for contracting processes and related monitoring of vendors that support provider engagement
• Support and lead business case development to support new tools and programs for provider enablement including all programmatic impact and financial analysis and projections
• Support the development of an enhanced provider performance reporting platform informed by internal SME's/stakeholders and external (providers). Partner with internal stakeholders to own/drive implementation of platform
• Support and guide development of platform updates and enhancements post-launch to ensure platform long-term effectiveness
• Monitor platform user experience and identify areas for enhancement
• Provide performance insights to inform payment models, contracting and navigation of members to high-value sites of care
• Build, manage, and lead a high performing team. Lead a team while fostering a healthy team culture, prioritizing equity and inclusion and providing a great place to work
• Serve as a resource and mentor to other Senior Managers and Program Managers as appropriate

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires at least 10 years of prior relevant experience, including 4 years of management experience
• Requires healthcare operations leadership experience
• Lean Sigma, Six Sigma or experience with business process management, or other quality improvement methodologies preferred
• Prior healthcare project and program management experience; PMP certification with experience in Agile project delivery methodology preferred
• Exceptional verbal and written communication and program/project management skills, including an ability to communicate effectively at an executive level, with a keen attention to detail
• Ability to prioritize and manage work and trade-offs against critical project timelines in a fast-paced environment
• Excellent influence and engagement skills in building alignment and accountability without formal ownership or authority over talent resources
• Ability to build strong and sustainable trusting relationships and the capability to interact within all levels of the organization, internally and externally
• Ability to work cooperatively and strategically in a team environment with all levels of professional, technical, and administrative staff and to integrate resources on a timely and organized basis
• Acumen to handle complex situations and multiple responsibilities simultaneously with the urgency of immediate demands on the operations
• Strategic thinker who has an eye for detail, is organized, and can manage multiple programs simultaneously
• Strong communicator with PowerPoint and storyboarding skills. Ability to present information clearly and concisely to various audiences
• Ability to deal with highly confidential information and act as a liaison between the business leaders and other constituencies, both internal and external

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