Senior HEDIS Audit Program Manager

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

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