What are the responsibilities and job description for the Program Manager Clinical, Senior position at Blue Shield of CA?
Your Role
The Care Management team is looking for a strategic leader with Care Management experience who can help support our Population Health Management (PHM) Medi-Cal Care Management line of business. The Program Manager Clinical, Senior will report to the Director of Care Management. In this role you will monitor and drive initiatives for the Transitional Care Services (TCS) program that will improve care transitions, reduce avoidable readmissions, enhance post discharge follow ups, and ensure compliance with regulatory requirements. You will serve as liaison between TCS, contracted provider organizations, hospitals, and internal stakeholders to optimize workflows, strengthen partnerships, and advance an integrated, whole health care model.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree and completion of an accredited educational program that meets the requirements for the applicable professional license isrequired
- Clinical license within the state of CA required (RN, LVN, NP, PA, LCSW etc )
- 5 or more years of relevant experience in managed care, population health, care management, transitional care services, or healthcare operations required.
- 3 or more years of program management, project management, or operational leadership experience preferred.
- Experience working collaboratively with hospitals, IPAs, physician groups, and multidisciplinary team preferred.
- Knowledge of DHCS, CMS, NCQA, and Medi-Cal managed care requirements preferred.
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.