Your Role

The Medical Care Programs team is responsible for managing programs that support members with their health care, drive cost of healthcare savings, and improve quality. The Clinical Program Manager, Consultant will report to the Senior Manager, Medical Care Programs. In this role you will manage a critical, cross-functional cost of healthcare taskforce, focused on a specific employer client. You will be responsible for impacting the cost of healthcare trend by direct intervention and by identifying and driving improvements at the macro and micro level.

Your Work

In this role, you will:

• Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, 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
• Review program budget variance and scope change requests, and participate in the budget-resolution process
• Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
• Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives
• Facilitate a cross-functional taskforce with specific cost of healthcare commitments
• Research and recommend interventions; identify and drive improvements and actions to significantly impact the cost of healthcare
• Maintain detailed documentation of taskforce activities and action items, as well as interventions, outcomes and impacts
• Partner closely with analytics teams to develop, analyze and distribute reporting
• Coordinate care directly with members, caregivers, providers and facilities
• Liaise with analytic and cost of healthcare groups across enterprise to compare trends, share knowledge, and measure outcomes
  

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires current California RN license
• Prefers familiarity with health care data and the health care delivery system in California; health plan or provider experience strongly desired
• Prefers Utilization Management experience; Care/Case Management experience also desired
• 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
• Experience in cost of health care analysis, population health outcomes, and/or program evaluation desired
• MS Access database experience desired

Pay Range

The pay range for this role is: $ 109120.00 to $ 163680.00 for California.

Note

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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