Healthcare Cost & Clinical Analytics Program Manager

Blue Shield of CA; Los Angeles (CA); Hybrid; USD 150,000 - 210,000; Full time

Job summary

Blue Shield of CA is seeking a Program Manager Clinical, Consultant to join the CMO team. The role analyzes clinical and financial data to identify trends, leads projects to address opportunities, and develops clear presentations with actionable recommendations.

You will facilitate cross-functional discussions with internal and external stakeholders to improve care and manage costs. The Hybrid Virtual Work arrangement allows full-time remote work with periodic in-office collaboration as needed,

Qualifications

• Bachelor's degree or higher required; 4 years of relevant experience in lieu of degree accepted
• 7+ years of relevant experience in healthcare program management or related field
• Active CA LVN/RN/NP/PA license required
• Experience with healthcare data and CA healthcare delivery system preferred
• Strong project management and organizational skills with ability to drive end-to-end initiatives
• Excellent written and verbal communication; ability to facilitate cross-functional discussions and influence outcomes
• Experience with cost of care analysis, population health outcomes, and program evaluation preferred
• Experience analyzing high-cost claims, cost drivers, and opportunities for medical cost reduction
• Knowledge of provider reimbursement methodologies (DRG, case rate, per diem, etc.) preferred
• Experience identifying fraud, waste, abuse, upcoding, and other claim-payment vulnerabilities desired
• Proficiency in data visualization and analytics tools to communicate findings (Power BI)
• Experience with employer fully insured and self-insured populations and large group accounts

Responsibilities

• Analyze clinical and financial data to identify trends and opportunities to improve care and manage costs
• Lead projects addressing identified opportunities and develop actionable recommendations
• Prepare presentations communicating clinical insights and recommended actions
• Facilitate meetings with internal and external stakeholders to drive actions
• Support system-level initiatives to reduce healthcare cost trends and improve outcomes
• Foster continuous learning and leadership development within the team
• Manage end-to-end taskforce activities with strong ownership and accountability

Skills

Project management

Cross-functional collaboration

Stakeholder facilitation

Data-driven decision making

Communication

Education

Bachelor's degree

Tools

Power BI

Job description

Blue Shield of CA is seeking a Program Manager Clinical, Consultant to join the CMO team. The role analyzes clinical and financial data to identify trends, leads projects to address opportunities, and develops clear presentations with actionable recommendations.

You will facilitate cross-functional discussions with internal and external stakeholders to improve care and manage costs. The Hybrid Virtual Work arrangement allows full-time remote work with periodic in-office collaboration as needed,