Clinical Cost & Care Analytics Program Manager (Hybrid)

Blue Shield of CA; Long Beach (CA); Hybride; USD 120 000 - 160 000; Plein temps

Résumé du poste

Blue Shield of CA is seeking a Program Manager Clinical, Consultant (Line of Business) to analyze clinical and financial data, identify trends, and lead cost-reduction initiatives for employer-funded health plans. You will manage cross-functional projects, develop presentations, and facilitate stakeholder meetings to drive cost improvements.

The role emphasizes strong leadership, critical thinking, and ongoing professional growth within a hybrid virtual work model in California.

Qualifications

• Bachelor's degree or equivalent with 4+ years of relevant experience
• At least 7 years of prior relevant experience
• Current California LVN, RN, NP, or PA license
• Familiar with health care data and CA health delivery system; health plan or provider experience preferred
• Strong organizational and/or project management skills
• Excellent written and oral communication; ability to facilitate cross-functional discussions
• Experience in cost of health care analysis, population health outcomes, and/or program evaluation
• Experience analyzing high-cost claims and cost drivers for medical cost reduction
• Ability to review complex claims for payment accuracy and coordination of benefits
• Knowledge of provider reimbursement methodologies (DRG, case rate, per diem, percentage-of-charge, LOA)
• Experience identifying fraud, waste, abuse, upcoding, improper billing vulnerabilities
• Experience performing root-cause analyses and building business cases for cost-of-care interventions
• Proficiency with Power BI and data visualization tools
• Experience with employer fully insured and self-insured populations, large group accounts and cross-functional stakeholder groups

Responsabilités

• Analyze clinical and financial data to identify trends and opportunities to improve care and manage costs
• Lead projects to address opportunities and develop presentations communicating insights and recommended actions
• Facilitate meetings with internal and external stakeholders and drive improvements in healthcare cost trends
• Support leaders with end-to-end task force activities and cross-functional collaboration
• Develop business cases for cost-of-care interventions and communicate findings effectively

Connaissances

Healthcare data analysis

Project management

Cross-functional facilitation

Communication skills

Cost of care analysis

Root cause analysis

Data visualization

Stakeholder management

Formation

Bachelor's degree

High School Diploma/GED with 4+ years experience

Outils

Power BI

Description du poste

Blue Shield of CA is seeking a Program Manager Clinical, Consultant (Line of Business) to analyze clinical and financial data, identify trends, and lead cost-reduction initiatives for employer-funded health plans. You will manage cross-functional projects, develop presentations, and facilitate stakeholder meetings to drive cost improvements.

The role emphasizes strong leadership, critical thinking, and ongoing professional growth within a hybrid virtual work model in California.