Program Manager Clinical, Principal

Blue Shield of CA; San Diego (CA); Hybrid; USD 140,000 - 190,000; Full time

Job summary

Blue Shield of California is seeking a Principal Program Manager, Clinical to lead a portfolio of behavioral health strategy and programs. You will collaborate with internal partners and external clinical stakeholders to develop, execute, and evaluate the behavioral health and addiction medicine ecosystem across lines of business.

The role emphasizes continuous quality improvement, NCQA/regulatory alignment, and delivering measurable member/provider experience improvements.

Qualifications

• Requires unrestricted CA license (RN, PA, LCSW, LMFT, LPCC, or PsyD).
• At least 10 years of prior relevant experience including service quality programs and/or service products, health plan operations, or equivalent.
• Experience with behavioral healthcare from multiple perspectives: vendor, payer/plan, MBHO, clinical, provider relations, products, program evaluation, IPA or medical group, hospital, etc.

Responsibilities

• Own portfolio of work and lead projects with internal partners for continuous quality improvement activities (e.g. meeting requirements for NCQA, regulatory/mandate programming).
• Support Blue Shield's behavioral health quality and integrated medical/behavioral health initiatives across all lines of business.
• Drive sustainable change across multiple stakeholders and stakeholders focused on continuous quality improvement initiatives & strategies.

Skills

CA license

Behavioral health

Quality improvement

Stakeholder management

Vendor management

Education

Bachelor’s degree or HS diploma

Job description

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.

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.

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.