Program Manager, Senior

Blue Shield of CA; Long Beach (CA); Hybrid; USD 120,000 - 150,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Program Manager for the Clinical Quality Analytics team. The role leads annual HEDIS audit operations, coordinating with external audit firms and internal stakeholders.

You will drive audit roadmaps, manage information requests, and oversee onsite activities, ensuring regulatory alignment and continuous improvement within a hybrid work model. The position requires strong program management experience, healthcare quality knowledge, and the ability to

Qualifications

• Bachelor's degree or high school diploma/GED with four additional years of relevant experience in lieu of a degree.
• At least 5 years of program/project management experience with ownership of cross-functional deliverables and risk management.
• Strong understanding of project/resource management and familiarity with portfolio tools.
• Excellent analytical, problem-solving, organizational and communication skills.
• Experience with HEDIS reporting and NCQA HEDIS audits, liaison to external audit firms preferred.
• Experience coordinating virtual HEDIS onsite audits and secure data exchanges preferred.
• Knowledge of health plan clinical quality operations and audit documentation practices preferred.
• PMP or related certification preferred, not required.

Responsibilities

• Lead the planning and execution of annual HEDIS audit operations.
• Act as the primary operational liaison to external HEDIS audit firms.
• Drive timely completion of audit roadmaps and information requests, onsite activities, and cross-functional deliverables.
• Coordinate virtual and onsite HEDIS activities and ensure secure data exchanges.

Skills

Stakeholder communication

Analytical thinking

Project coordination

Cross-functional collaboration

Written and verbal communication

Education

Bachelor's degree or equivalent experience

Tools

Enterprise PM tools

Job description

Your Role

The Clinical Quality Analytics team oversees clinical quality measurement, HEDIS reporting, and related data and audit operations that support quality performance, accreditation, and regulatory requirements. Reporting to the Director of Clinical Quality Analytics, the Senior Program Manager will lead the planning and execution of annual HEDIS audit operations. This role serves as the primary operational liaison to external HEDIS audit firms and drives timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables.

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 with four additional years of relevant experience in lieu of a degree.

• At least 5 years of prior relevant experience in program or project management experience, including ownership of complex cross-functional deliverables, milestone tracking, risk management, and stakeholder communication.

• Solid understanding of project and resource management, business acumen, and experience working in complex delivery environments; familiarity with enterprise project or portfolio management tools.

• Strong analytical, problem-solving, organizational, and written and verbal communication skills; ability to independently drive action and influence stakeholders without direct authority.

• Experience with HEDIS reporting and NCQA HEDIS compliance audits, particularly serving as a liaison to external HEDIS audit firms, strongly preferred.

• Experience coordinating virtual HEDIS onsite audits, audit roadmaps, audit information requests, and secure data exchanges preferred.

• Knowledge of health plan clinical quality operations, supplemental data source processes, and audit documentation practices preferred.

• PMP or other relevant project management certification preferred; not required.

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.