Senior HEDIS & Clinical Quality Program Lead

Blue Shield of CA; Springfield Meadows (CA); Hybride; USD 120 000 - 180 000; Plein temps

Résumé du poste

Blue Shield of CA is seeking a Senior Program Manager for the Clinical Quality Analytics team to lead planning and execution of annual HEDIS audit operations, ensuring regulatory compliance and data integrity.

You will serve as the primary operational liaison to external HEDIS audit firms, coordinate audit roadmaps, information requests, and onsite activities, and partner with cross-functional teams in a hybrid in-office/work model.

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 or project management experience with ownership of cross-functional deliverables, milestone tracking, risk management, and stakeholder communication.
• Solid understanding of project/resource management, business acumen, and experience in complex delivery environments; familiarity with enterprise PM tools.
• Strong analytical, problem-solving, organizational, and written and verbal communication skills; ability to independently drive action and influence stakeholders.
• Experience with HEDIS reporting and NCQA HEDIS compliance audits; liaison to external HEDIS audit firms preferred.
• Experience coordinating virtual HEDIS onsite audits, audit roadmaps, and information requests; secure data exchanges preferred.
• Knowledge of health plan clinical quality operations and audit documentation practices preferred.
• PMP or other project management certification preferred; not required.

Responsabilités

• Lead planning and execution of annual HEDIS audit operations.
• Serve as primary operational liaison to external HEDIS audit firms.
• Drive timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables.
• Collaborate with cross-functional teams to ensure audit readiness within a hybrid workplace.

Connaissances

HEDIS knowledge

Project management

Stakeholder communication

Data analysis

Cross-functional collaboration

Formation

Bachelor's degree or equivalent experience

Outils

PM tools

Description du poste

Blue Shield of CA is seeking a Senior Program Manager for the Clinical Quality Analytics team to lead planning and execution of annual HEDIS audit operations, ensuring regulatory compliance and data integrity.

You will serve as the primary operational liaison to external HEDIS audit firms, coordinate audit roadmaps, information requests, and onsite activities, and partner with cross-functional teams in a hybrid in-office/work model.