Program Manager, Senior, Medi-Cal QI

Blue Shield of California; California; Ibrido; USD 91.000 - 136.000; Tempo pieno

Descrizione del lavoro

Blue Shield of California is seeking a Program Manager, Senior, Quality Improvement to design and manage Medi-Cal quality initiatives, driving improvements across HEDIS, MCAS, CAHPS, NCQA health plan ratings, DMHC metrics, and Medicaid QRS by collaborating with internal Quality Program Managers, provider organizations, external vendors, and community partners.

This hybrid field-based role serves the Los Angeles area, with in-office days in Long Beach or Woodland Hills and occasional clinic

Competenze

• Bachelor’s degree or High School Diploma/GED with 4 years of additional relevant experience.
• Minimum of 5 years of healthcare experience in Quality Improvement/Quality Management with demonstrated improvement skills.
• 3 years experience with IPAs, medical groups, FQHCs, or Medi-Cal providers.
• Strong project/program management experience.
• Knowledge of HEDIS and accrediting bodies (NCQA, DHCS) desired.

Mansioni

• Plan, execute, and evaluate large, complex quality initiatives to improve Medi-Cal performance.
• Develops measurement strategies for large change initiatives.
• Lead programs from pilot to delivery and spread, with continuous improvement.
• Be an expert on quality initiatives and policies to guide internal teams.
• Lead interventions to improve HEDIS, MCAS, CAHPS, NCQA ratings, DMHC HEQMS, and Medicaid QRS.

Conoscenze

Quality Improvement

Project Management

Healthcare Provider Collaboration

Strategic Thinking

Stakeholder Engagement

Formazione

Bachelor’s degree or High School Diploma/GED with 4 years of relevant experience

Strumenti

Cozeva

Tableau

Descrizione del lavoro

Your Role

The Medi-Cal Quality Improvement (QI) team is responsible for developing and executing targeted quality improvement initiatives that support the Medi-Cal line of business and drive improved performance across quality rating systems, including but not limited to, Healthcare Effectiveness Data Information Set (HEDIS), Managed Care Accountability Set (MCAS), Consumer Assessment of Healthcare Providers and Systems System (CAHPS), National Committee for Quality Assurance (NCQA) Health Plan Ratings, Department of Managed Health Care (DMHC) Health Equity Quality Measure Set (HEQMS), and Medicaid Quality Rating System (QRS). The Program Manager, Senior, Quality Improvement, will report to the Medi-Cal Quality Improvement Team's Senior Manager. In this role, you will design, develop, and manage tertiary provider groups' quality interventions, toolkits, clinic days, and analytic insights that support measurable improvement in quality performance. You will support and partner with internal Quality Program Managers, internal cross-functional teams, clinical leadership, provider organizations, external vendors, and community-based organizations to execute improvement strategies, strengthen provider relationships, and align current and future QI programs with long-term organization goals.

Job Description

Your Role

The Medi-Cal Quality Improvement (QI) team is responsible for developing and executing targeted quality improvement initiatives that support the Medi-Cal line of business and drive improved performance across quality rating systems, including but not limited to, Healthcare Effectiveness Data Information Set (HEDIS), Managed Care Accountability Set (MCAS), Consumer Assessment of Healthcare Providers and Systems System (CAHPS), National Committee for Quality Assurance (NCQA) Health Plan Ratings, Department of Managed Health Care (DMHC) Health Equity Quality Measure Set (HEQMS), and Medicaid Quality Rating System (QRS). The Program Manager, Senior, Quality Improvement, will report to the Medi-Cal Quality Improvement Team's Senior Manager. In this role, you will design, develop, and manage tertiary provider groups' quality interventions, toolkits, clinic days, and analytic insights that support measurable improvement in quality performance. You will support and partner with internal Quality Program Managers, internal cross-functional teams, clinical leadership, provider organizations, external vendors, and community-based organizations to execute improvement strategies, strengthen provider relationships, and align current and future QI programs with long-term organization goals.

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.

This is a hybrid field-based role serving the Los Angeles area.

The position requires a minimum of five to eight days per month working from the Long Beach or Woodland Hills offices and/or visiting local clinics. Clinic visits typically occur 1–2 days per week. Some evening and Saturday hours may also be required.

Responsibilities

Your Work

• Responsible for planning, execution, and evaluation of large and complex program initiatives to improve quality performance in the Medi-Cal line of business.
• Develops and monitors measurement strategies for large change and improvement initiatives.
• Manages program(s) from initiation/pilot phase through delivery/spread and monitors for continuous improvement.
• As part of a broader QI team, influences the business unit, strategies, and objectives.
• Becomes an expert in company quality initiatives, as well as the products, functions, marketing, and/or service policies and procedures that support those initiatives.
• Serves as a quality expert with internal constituents to drive successful improvement initiatives in the Medi-Cal line of business.
• Leads and supports interventions to improve performance on HEDIS, MCAS, CAHPS, NCQA Health Plan Ratings, DMHC HEQMS, and Medicaid QRS.
• Leads in-person community-based clinic days at Community Based Organizations in Los Angeles County (average of 2 per month, as scheduled).
• Educates and works with external partners and participating practices as needed to identify innovation opportunities and adopt improvement actions. Partners with providers, in-person, at clinic locations to identify practice barriers and areas for improvement.
• Exercises independent judgment in developing methods, techniques, and evaluation criteria for obtaining results.
• May assist in the planning and direction of budgets.
• May act as the business unit liaison to corporate initiatives and projects.

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.
• Minimum of 5 years of healthcare experience in Quality Improvement/Quality Management, including demonstrated experience with quality improvement, process improvement, and practice transformation techniques.
• Requires 3 years experience working with IPAs, medical groups, FQHCs, and/or providers who provide care for the Medi-Cal population.
• Previous project/program management experience required.
• Knowledge of HEDIS and accrediting body requirements (e.g., NCQA, DHCS) desired.
• Proficiency with Cozeva application highly desired.
• Tableau for quality reporting is preferred.
• Experience with review of medical records to identify service compliance and missed opportunities preferred.
• Experience in the CA delegated model or with highly integrated clinical delivery systems 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 needs.

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.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

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.

Please click here for further physical requirement detail.

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.

JOB INFO

Job Identification : 20262353

Job Category : Business Operations

Posting Date : 2026-11-05T21:36:07+00:00

Job Schedule : Full time

Locations :

Long Beach, CA, United States

Woodland Hills, CA, United States

Pay Range for California : $90860.00 to $136290.00

Pay Range for Bay Area : $102424.00 to $153636.00

Note : Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Role can be filled by a candidate requiring sponsorship : No