Medicare Star Program Manager, Principal

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: June 13, 2022

Job Description:

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen. Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us Your Role The Medicare Star Program team is accountable for leading the strategy to improve performance on the Medicare Star HEDIS measures. The Medicare Star Program Manager, Principal will report to the Senior Manager, Medicare Star Program. In this role you will be responsible for leading quality improvement initiatives and building strong collaborative relationships with external provider group partners to drive Medicare HEDIS, Part D and CAHPS outcomes. To do this, the Program Manager, Principal is expected to engage across internal, cross-functional teams and work with external provider organizations to identify, develop and manage end-to-end programs to ensure timely execution of deliverables, that align with strategic goals and are within budget. Also, the Program Manager, Principal will help provide overall program leadership for the Medicare Stars Provider Engagement Strategy. 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 complex projects/programs spanning across business areas Determine key business issues, develop effective action plans and implement to successful conclusion Provide steady leadership in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model Serve as a quality outcome (HEDIS, Medicare Star, CAHPS) expert with internal and external constituents Frequently responsible for providing guidance, coaching, and training to other team members and employees across the company within area of expertise Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders Develops and monitors measurement strategies for large change and improvement initiatives As part of a broader QI team, influences the business unit, strategies and objectives Provides input into designing strategies for alignment with business unit goals and objectives Establish / apply quality objectives, criteria, standards and levels using appropriate quality management methods, with stakeholder input (e.g., key performance indicators, scope definition) Your Knowledge and Experience Requires a bachelor's degree or prior relevant experience Requires at least 10 years of prior relevant experience Master's Degree preferred in a healthcare field (MPH, MSN, MHA, MSW) is preferred Clinical licensure as a Registered Nurse (RN/BSN), NP, PA, Dietician, or master's degree (MSW); or equivalent experience is preferred. Requires at least 5 years of healthcare experience in Quality Management, Utilization Management, or Case Management Previous project/program management experience in tracking, planning projects, working with large data sets and making data - driven analytical decisions required Extensive experience with Medicare Star Program, Dual Eligible, Special Needs or Medi-Cal quality improvement requirements preferred Experience with quality improvement/process improvement techniques required Experience in the CA delegated model or with highly integrated clinical delivery systems preferred Intermediate level of proficiency with MS Excel, Visio, and Power Point Requires ability to perform up to 10% travel Our Values Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals PDN-9648f448-f89a-4d90-ad7b-b544acdfc4e1

Keywords: Blue Shield of California, Rancho Cordova , Medicare Star Program Manager, Principal, Executive , Rancho Cordova, California