Program Manager Clinical, Principal

Your Role

The Clinical Program Manager, Principal in collaboration with the Regional Medical Director and the CMO Team for Commercial Business will be responsible for collaborating with all internal stakeholders and externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction) with a focus on execution to drive and accelerate improvements in primary care for all patients. This role will report to the Regional Medical Director.

Your Work:

In This Role, You Will:

• Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California’s strategic goals
• Consult with all levels (including senior management) making recommendations and influencing 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
• Perform data analysis for all lines of business: Analyze data in collaboration with Regional Medical Director for trends, drivers, and key initiatives. Incorporate the analysis into meaningful discussions with Group/IPA
• Identify opportunities around utilization, quality, and clinical initiatives: Work side by side with internal and external partners in the design and launch of clinical programs focused on high-risk members, hospital initiatives, and behavioral health as well as internal innovation programs
• Partner with medical groups to co-create programs encompassing a full spectrum of initiatives around disease management, complex care management, transitions of care and site of service, ensuring optimal utilization, access, and quality of care for members
• Lead with a collaborative approach and an understanding of existing resources and relationships between/among partner organizations while moving them towards constructive change
• Work cross functionally with Blue Shield of California internal teams to provide support both ad hoc and for recurrent initiatives

Your Knowledge and Experience

• Requires a current, active California RN, NP, or PA license
• Requires a bachelor’s degree; advanced degree is preferred
• Requires a minimum of 10 years of prior relevant clinical or job related experience
• Requires previous health plan experience with understanding of Accountable Care Organizations (ACO), global versus shared risk financial arrangements, quality metrics and member experience.  Experience in case utilization and utilization management and managed care delegated models is a plus.
• In-depth understanding of data analytics with mastery of excel and an ability to use multiple data platforms for internal and external communication.
• Strong PowerPoint application skills to create executive summaries and presentation decks.
• Excellent verbal and written communication style to drive positive outcomes
• Ability to be resourceful and collaborative; a team collaborator with strong listening skills and the ability to offer creative solutions to drive consensus.