Program Manager Clinical, Principal

Blue Shield of California; California; Híbrido; USD 140.000 - 190.000; Jornada completa

Descripción de la vacante

Blue Shield of California is seeking a Principal Program Manager to lead behavioral health strategy and program delivery across our clinical market engagement team. You will partner with internal and external stakeholders to advance quality, integrated care, and regulatory initiatives, including NCQA requirements and member/provider experience improvements.

In a hybrid workplace, you will manage complex portfolios, influence senior leaders, and drive cross-functional projects that advance

Formación

• Bachelor’s degree or higher with 4+ years of relevant experience in healthcare quality/operations.
• Unrestricted California professional license as listed (RN/PA/LCSW/LMFT/LPCC/PsyD).
• 10+ years in service quality programs, health plan operations, or equivalent.

Responsabilidades

• Strategically align projects with Blue Shield of California goals.
• Consult with senior management; influence decisions.
• Leverage cross-functional relationships to drive initiatives.
• Plan and implement complex programs in mental health and substance use.
• Identify clinical and business issues; develop and execute action plans.
• Design and manage a high-performance portfolio across prevention and clinical care.
• Represent Behavioral Health in workgroups, forums, and committees.
• Communicate progress and risks to stakeholders via PM tools.

Conocimientos

Strategic thinking

Cross-functional collaboration

Stakeholder management

Project management

Executive communication

Educación

Bachelor’s degree or equivalent with 4+ years relevant experience

Unrestricted CA license (RN/PA/LCSW/LMFT/LPCC/PsyD)

Descripción del empleo

Your Role

The Blue Shield Behavioral Health Clinical Market Engagement, Strategy and Programs team works with internal and external business and clinical partners to develop, execute, and evaluate Blue Shield of CA’s strategy and ecosystem for behavioral health and addiction medicine. This Principal Program Manager, Clinical role will report to the Director of Behavioral Health Clinical Market Engagement, Strategy and Programs. In this role you will work with cross-functional internal partners support Blue Shield’s behavioral health quality and integrated medical/behavioral health initiatives across all lines of business. The role will own a portfolio of work and lead projects with internal partners for continuous quality improvement activities e.g. meeting requirements for NCQA, regulatory/mandate programming, member/provider experience improvement.

Job Description

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

In this role, you will:

• Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California strategic goals.
• Consult with all levels including senior management, make recommendations, and influence decision-making.
• Leverage cross-functional internal and external relationships to drive initiatives forward.
• Plan and implement multiple and extremely complex projects/programs spanning across business areas and quality improvement/management initiatives relative to mental healthcare and substance abuse services.
• Determine key clinical and business issues, develop effective action plans and implement to successful conclusion.
• Design, execute, evaluate sustained high-performance portfolio of products across a prevention & clinical spectrum.
• Represent Blue Shield Behavioral Health at relevant quality and strategy workgroups, forums, and in committees.
• Manage regular internal stakeholder communications through project & product management tools that identify progress, risks, etc.

Qualifications

Your Knowledge and Experience

• Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree and completion of an accredited educational program that meets the requirements for the applicable professional license isrequired
• Requires an unrestricted CA license RN, PA, LCSW, LMFT, LPCC, or PsyD
• Requires at least 10 years of prior relevant experience including service quality programs and/or service products, health plan operations, or equivalent.
• Requires experience with behavioral healthcare from any combination of perspectives: vendor, payer/plan, MBHO, clinical, provider relations, products, program evaluation, IPA or medical group, hospital, etc.
• Requires experience driving sustainable change across multiple stakeholders focused on continuous quality improvement initiatives & strategies
• Vendor and/or product development and management experience including proposal development, selection, evaluation, marketing and communications is preferred.
• Experience with integrated behavioral/medical health care models and practice considerations is preferred.

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.