Senior HEDIS Audit Program Lead

Blue Shield of CA; San Diego (CA); Hybrid; USD 120,000 - 180,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of CA is seeking a Senior Program Manager to oversee the planning and execution of annual HEDIS audit operations. You will be the primary liaison to external HEDIS audit firms and drive timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables.

The ideal candidate has 5+ years in program or project management, with strong skills in stakeholder communication, risk management, and the ability to influence without formal authority.

Qualifications

• Bachelor's degree or higher with four additional years of relevant experience in lieu of a degree.
• 5+ years of program or project management experience with ownership of cross-functional deliverables, milestone tracking, risk management, and stakeholder communication.
• Strong understanding of project and resource management; familiarity with enterprise project or portfolio management tools.
• Excellent 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; serving as liaison to external HEDIS audit firms is strongly preferred.
• Experience coordinating virtual HEDIS onsite audits, audit roadmaps, 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.

Responsibilities

• Lead the planning and execution of annual HEDIS audit operations.
• Serve as the primary operational liaison to external HEDIS audit firms.
• Drive timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables.
• Coordinate cross-functional stakeholders to ensure audit readiness and compliance.
• Maintain awareness of NCQA HEDIS standards and ensure alignment across programs.

Skills

Program management

Cross-functional leadership

Risk management

Stakeholder communication

Analytical thinking

Problem solving

Written and verbal communication

Influencing without authority

Education

Bachelor's degree

High school diploma + 4 years relevant experience

Tools

Enterprise PM tools

Job description

Blue Shield of CA is seeking a Senior Program Manager to oversee the planning and execution of annual HEDIS audit operations. You will be the primary liaison to external HEDIS audit firms and drive timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables.

The ideal candidate has 5+ years in program or project management, with strong skills in stakeholder communication, risk management, and the ability to influence without formal authority.