Blue Shield of California · 2 days ago
Program Manager, Consultant (Clinical Quality)
California, United States
Full-time
Hybrid
Senior Level
7+ years expBlue Shield of California is a nonprofit healthcare organization committed to transforming health care to be more affordable and of higher quality. The Program Manager, Consultant will lead projects to support the Medicare Stars - HEDIS Program, managing provider groups and collaborating with key stakeholders to improve Medicare Star Ratings.
Financial ServicesHealth InsuranceNon Profit
Responsibilities
Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation
Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities
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
Track and manage policy changes to the Medicare Star program and keep executive sponsors and key stakeholders well-informed of the changes and impact. Also, responsible for working with key stakeholders to execute action plans that comply with new changes. Acting liaison and subject matter expert on CMS communications
Ensures project goals and objectives are accomplished within designated timeframes and budget constraints. Also, regularly informs executive sponsors and key stakeholders of project status
Train and mentor department coordinators and administrative staff to assist in project management, if appropriate
Collaborate with key stakeholders to identify gaps, barriers and opportunities for improvement, and develop and implement enhancements that align with our critical few goals and glide path high performance
Educate and work with external partners and participating practices as needed to identify innovation opportunities and adopt Star-related improvement actions
Qualification
Required
Requires a bachelor's degree or equivalent experience
Requires at least 7 years of prior relevant experience
Knowledge of Medicare Star Program requirements required
HEDIS quality improvement experience required
Demonstrated project/program management experience required
Intermediate to Advanced level of proficiency with Microsoft Power Point, Excel
Preferred
Lean/Six Sigma/Performance Improvement training
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
H1B Sponsorship
Blue Shield of California has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (1)
2022 (41)
2021 (20)
2020 (31)
Funding
Current Stage
Late StageLeadership Team
Gary Culp
Senior Vice President, Government Markets
Gregory Siebert
Senior Vice President Provider Partnerships & Network Management
Recent News
2026-01-13
Fierce Healthcare
2025-12-15
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