Program Manager, Senior, Medi-Cal QI

Blue Shield of CA; Long Beach (CA); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Blue Shield of California is seeking a Senior Program Manager, Quality Improvement to lead Medi-Cal quality initiatives. The role focuses on designing, implementing, and measuring quality interventions, toolkits, and clinic days to drive performance across HEDIS, MCAS, CAHPS, and other measures.

This hybrid, field-based position serves the Los Angeles area with regular in-office days at Long Beach/ Woodland Hills and clinic visits, requiring some evenings and Saturdays as needed.

Qualifications

• Bachelor's degree or equivalent with 4 years of relevant experience.
• 5+ years of healthcare quality improvement/quality management experience.
• 3+ years working with IPAs, medical groups, FQHCs, or Medi-Cal providers.
• Experience in project or program management.
• Knowledge of HEDIS and NCQA/DHCS requirements preferred.
• Proficiency with Cozeva application preferred.
• Tableau experience for quality reporting preferred.
• Experience reviewing medical records for service compliance.
• Experience in CA delegated model or integrated clinical delivery systems preferred.

Responsibilities

• Design, develop, and manage quality improvement interventions, toolkits, clinic days, and analytic insights.
• Collaborate with internal Quality Program Managers and cross-functional teams to execute improvement strategies.
• Support provider organizations, external vendors, and community partners to strengthen relationships.
• Align current and future QI programs with long-term organizational goals.

Skills

Quality Improvement

Project Management

Healthcare Quality

Data Analysis

Stakeholder Collaboration

Tableau

Cozeva

IPA coordination

Education

Bachelor's degree or equivalent

Tools

Cozeva

Tableau

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.

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.