Operations Specialist, Principal

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: September 17, 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 Quality Governance team ensures Blue Shield's ongoing compliance with regulatory requirements for the Clinical Quality Department, through oversight quality committees, collection of documentation that shows monitoring and tracking of key metrics and their related functions and ensuring that new requirements are rolled out and tracked. The Principal Operations Specialist will report to the Quality Governance Senior Manager, Program and Project Management. In this role you will be the subject matter expert on quality related operational workflows, databases, systems and applications, procedures, tools and documentation. You will work to enhance the department's operating efficiency, attention to detail/quality, and technical skill levels of staff. You will create/present executive level reports and conduct root cause analyses, as well as make recommendations for addressing identified issues. Your Work In this role, you will: Act as a lead subject matter expert to review operational workflows of high complexity for multiple departments, identifying problems and developing improvements, modifications, and enhancements
Create tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff
Provide leadership in tracking and communicating workflow and system changes to appropriate sources
Develop and generate reports for management review
Participate as a Subject Matter Expert (SME) in the development of written guidelines
Monitors and reports operational timeliness of Potential Quality Issues (PQIs) and other quality related regulatory turnaround times (for in-house and/or external specifications and standards)
Reviews cross departmental systems and applications and recommends edits/changes to ensure streamlined processes
Revises policies and procedures to ensure compliance with new / updated regulatory changes
Develops and leads training opportunities for staff related to above requirements
Responsible for timely escalation of issues and subsequent coordination of Corrective Action Plans (CAPs) Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 10 years of prior relevant experience Excellent presentation/design, speaking, analytic and problem-solving skills Requires deep knowledge of quality related activities for healthcare environment - typically obtained through advanced education combined with experience Must have broad knowledge/experience in project management and be comfortable managing large multi-departmental projects with limited oversight Must be a team player, must build relationships with business partners internal and external to department, and be persuasive/influencing in order to achieve aims 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

Keywords: Blue Shield of California, Rancho Cordova , Operations Specialist, Principal, Other , Rancho Cordova, California