Senior HEDIS Audit Programs Lead

Blue Shield of CA; Redding (CA); Hybrid; USD 120,000 - 160,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Program Manager for the Clinical Quality Analytics team to lead annual HEDIS audit operations, manage roadmaps, information requests, and onsite activities, and act as the primary liaison to external HEDIS audit firms.

In this hybrid, in-office role, you will coordinate cross-functional deliverables, drive timely outcomes, and work to ensure compliance with NCQA HEDIS standards while supporting quality performance, accreditation, and regulatory requirements.

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 prior relevant experience in program or project management; ownership of complex cross-functional deliverables, milestone tracking, risk management, and stakeholder communication.
• Solid understanding of project and resource management; 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; liaison to external HEDIS audit firms 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 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.

Skills

Program management

Stakeholder communication

Cross-functional collaboration

Risk management

Analytical thinking

Project scheduling

Education

Bachelor's degree or equivalent

PMP or project management certification (preferred)

Tools

MS Project

Jira

Job description

Blue Shield of CA is seeking a Senior Program Manager for the Clinical Quality Analytics team to lead annual HEDIS audit operations, manage roadmaps, information requests, and onsite activities, and act as the primary liaison to external HEDIS audit firms.

In this hybrid, in-office role, you will coordinate cross-functional deliverables, drive timely outcomes, and work to ensure compliance with NCQA HEDIS standards while supporting quality performance, accreditation, and regulatory requirements.