Program Manager, Senior

Your Role

The Quality Improvement Team is accountable for quality ratings of the organization and the development and execution of targeted, quality improvement initiatives in support of the commercial medical groups, hospitals, affiliated providers, and our CalPERS membership. The Program Manager, Senior will report to the Manager, Program and Project Management. In this role you will be responsible in the commercial line of business for the development and execution of targeted, quality improvement initiatives with our external provider group partners to achieve improved outcomes in HEDIS measures. You will partner with other lines of business and align quality interventions to the organizational strategies for HEDIS, QRS, CAHPS, and our CalPERS membership. The Program Manager will manage to data driven outcomes and targets helping to facilitate getting provider data into our Blue Shield systems.

Your Knowledge and Experience

Requires a bachelor's degree or equivalent experience

Requires at least 5 years of prior relevant experience

A clinical license (i.e. LVN, RN, NP, PA, MSW, CPhT, etc) strongly preferred

Requires experience in driving performance within Quality Rating Systems, specifically NCQA, HEDIS, and CAHPS measurement

Requires demonstrated experience in executing quality improvement or process / performance improvement with a measurable outcome or data supported impact, including performance improved or member experience impact, either in a health plan quality team or in an outpatient healthcare setting

Requires previous project / program management experience including planning and monitoring projects / programs from initiation through delivery

Requires demonstrated facilitation skills that resulted in measurable impact to HEDIS or CAHPS outcomes

Highly adept computer skills; demonstrated mastery of all MS Office products (including Outlook, Excel, PowerPoint, Word); ability to analyze and manipulate data