Program Manager, Consultant-Short-Term-HEDIS

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 120,000 - 160,000; Full time

Job summary

Blue Shield of California seeks a Program Manager, Consultant (Coordinated Outcomes) to lead improvement of preventive dental care outcomes across multi-site networks, coordinating with medical and dental teams. You will plan and execute data-driven strategies, dashboards, and provider engagement initiatives to close care gaps.

The role requires strong analytics, strategic planning, and stakeholder management, with a hybrid schedule anchored near Rancho Cordova, CA.

Qualifications

• Bachelor's degree or higher with 4 years of relevant experience in lieu of a Bachelor's degree
• Minimum 7 years of prior relevant experience
• Must reside within 50 miles of Rancho Cordova office and hybrid schedule

Responsibilities

• Create and drive improvement strategy for preventive care outcomes in coordinated pediatric and adult dental health
• Lead annual planning for quality/improvement/equity activities and manage resources, workplans and timelines
• Develop and implement operational roadmaps for care gap closure and data system improvements
• Communicate complex ideas clearly to diverse audiences

Skills

Quality ratings

HEDIS knowledge

CAHPS knowledge

Project management

Executive communication

Self-starter

Data storytelling

Education

Bachelor's degree

Master's degree

Tools

Dashboards

Data systems

PowerPoint

Job description

Your Role

The Clinical Quality [Commercial Populations] team is accountable for the quality ratings achieved for the organization's Commercial populations, as well as the preventive care strategy and outcomes for Blue Shield of California's Commercial members. Clinical Quality also manages financial, multi-site, system, and transitions of care risks associated with Quality performance. The Program Manager, Consultant (Coordinated Outcomes) will report to the Snr Manager/Director of Clinical Quality. In this role you will create and drive the improvement strategy for preventive care outcomes in coordinated pediatric and adult dental health, with a focus on multi-site care, coordinating care with medical, and emerging HEDIS measures of dental health outcomes and improvements. Additionally, in close partnership with department leadership, you will develop and implement the operational roadmap for care gap closure through the identification, project management and execution of data system improvements, member support interventions, or provider engagement strategies, including but not limited to education, support and remediation activities. Specifically, the role leads annual planning for quality/improvement/equity activities and negotiates resources, workplans and timelines to achieve HEDIS and CAHPS results, as well as state contract requirements related to preventive dental health services, follow up care following emergency care, and equitable health outcomes. The role is accountable for refreshing, executing and evaluating annual plans and strategies that cascade and scale to multiple teams and functions.

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.

Must reside within 50 miles of the Rancho Cordova office and be able to work a hybrid schedule (approximately 2 days per week / 8 days per month onsite).

Your Knowledge and Experience

• Requires a Bachelor's degree or High School/GED and an additional 4 years of relevant experience in lieu of a Bachelor's degree
• Requires a minimum of 7 years of prior relevant experience
• Must reside within 50 miles of the Rancho Cordova office and be able to work a hybrid schedule (approximately 2 days per week / 8 days per month onsite)
• Master's degree preferred
• Requires demonstrated knowledge of Quality Ratings Systems, including HEDIS, and CAHPS measurement. Experience building related dashboards/data systems preferred
• Requires a minimum of 5 years of demonstrated experience in dental health systems, dental networks, dental workflows and dental improvement initiatives
• Requires experience executing improvement initiatives within or with a California dental network, as well as experience executing member or provider engagement interventions in support of preventive care outcomes and improvement for a diverse member population
• Requires demonstrated experience with complex analytic modeling and operational planning in environments of rapid execution as well as demonstrated knowledge of strategic planning and multi-year project and program management
• Requires demonstrated ability to communicate complex ideas about dental networks, providers, business and quality models, in a manager that is simple and succinct, both verbally and in writing. This includes the ability to speak comfortably and extemporaneously to diverse audiences.
• Required to be capable of self-management and exhibit as a self-starter
• Required to have demonstrated experience and strong skills assembling presentations for executive audiences, including guiding teams to gather pertinent information, and navigating a variety of presentation formats for various audiences

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.