Your Role

The Care Management Department, which oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of NCQA (National Committee for Quality Assurance) standards. The Clinical Program Manager, Principle will report to the Director of Care Management. In this role you will provide oversight for clinical programs, ensuring alignment with organizational goals and objectives.

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
• Analyze program data and metrics to identify trends, opportunities for improvement, and areas of risk.
• Assist with monitoring completion of regulatory activities
• Lead initiatives to enhance the quality, efficiency, and effectiveness of clinical programs.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 10 years of prior relevant experience
• Requires excellent analytical skills, with the ability to interpret complex data and make data-driven decisions
• Requires 3-5 years Care Management experience in a health plan or other managed care setting
• In-depth knowledge of compliance and regulatory requirements, with specific expertise in NCQA standards desired
• Requires exceptional communication skills, both verbal and written
• Requires a valid California RN license

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.