Note: The job is a remote job and is open to candidates in USA. Blue Shield of California is a nonprofit health plan focused on lowering healthcare costs, improving quality, and enhancing member and physician experiences. The Program Manager Clinical, Consultant analyzes clinical and financial data, leads cross-functional initiatives, develops recommendations and presentations, and drives improvements in healthcare cost trends for employer-funded health insurance.
Responsibilities
- Provide analysis, leadership, and guidance, for a given line of business, including opportunity identification, business case creation, and implementation
- Provide steady leadership in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model
- Create presentations and manage meeting requests at a high level
- Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
- Collaborate with analytics, actuarial, and quality teams to develop, analyze, and distribute reports, and document program activities, interventions, and outcomes
- Perform deep-dive analysis of high-cost claims, vendor-identified population and other defined groups, producing case studies, reports and presentations
- Organize and lead cross-functional meetings, foster teamwork and collaborative problem-solving across diverse stakeholders
- Facilitate cross-functional taskforces with specific cost of healthcare commitments
- Research and recommend interventions; identify and drive improvements and actions to significantly impact the cost of healthcare
- Partner closely with analytics teams to develop, analyze and distribute reporting
- Liaise with analytic and cost of healthcare groups across the enterprise to compare trends, share knowledge, and measure outcomes
Skills
- Requires a bachelor's degree or equivalent experience
- Requires at least 7 years of prior relevant experience
- Requires current California LVN, RN, NP, or PA license
- Strong organizational and/or project management skills, consistent ability to “self-start” and take ownership of end-to-end taskforce activities
- Excellent written and oral communication skills, ability to facilitate cross-functional discussions, lead teams through influence to drive actions and outcomes
- Prefers familiarity with health care data and the health care delivery system in California; health plan or provider experience strongly desired
- Experience in cost of health care analysis, population health outcomes, and/or program evaluation desired
Benefits
- Leadership development and opportunities to grow personally, professionally, and financially.
- For most teams, coming into the office two days per week.
- This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
- Flexibility in the workplace model.
- Reasonable accommodations for employees with medical conditions that may impact their ability to work in-office.
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