*Please note: There is a Mandatory Nurse Assessment that is required for you to take following the completion of your application with us. Once you complete the Application, you will receive a confirmation email of your submission. In the second paragraph it will state how to complete the Nurse Assessment.
Program Manager Clinical-Consultant (HCQA) - Markets Support
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. This individual will ensure efficient operations and develop iterative processes in operations and implementations.
Key business partner to internal and external stakeholders including Sales, Account Management, Medical Directors, departments within Medical Care Solutions and Health Care Quality and Affordability, Implementation, new and renewing clients and Third- Party Administrators
Oversee program and group implementations, RFP responses, internal and external client audits, program presentations for clients, creation and maintenance of program materials
Responsible for driving collaboration within Medical Care Solutions to maximize effectiveness and efficiency related to operational and system enhancements
Maintain intranet site with program collateral
Work in collaboration with other BSC teams to execute on initiatives and programs, including data exchanges and workflow with Third Party Administrators
Maintain an online system to intake and manage requests
Research and prepare concise high-cost case summaries, collaborate with medical directors and account teams on client presentations
Work with clients, account management, medical directors, and other key stakeholders to facilitate client-specific case rounds discussions on high cost cases, or escalated cases
Triage operational escalations that are clinical in nature, and present findings when necessary to account managers, clients, medical directors, and other key stakeholders
Ability to resolve numerous and undefined issues that require detailed information gathering, analysis and investigation to understand the problem; problems are difficult and moderately complex, typically impact multiple departments or specialties, and are usually solved through drawing from prior experience and analysis of issues
Develop new perspectives and innovative approaches on existing problems
Lead critical initiatives that require cross team or business unit oversight as assigned, including support to key customers and programs
Work cross functionally with Blue Shield of California internal teams to provide support both ad hoc and recurrent on clinical initiatives