Your Role

The Care Management department, which oversees all care management for the Dual Special Needs Program (DSNP) line of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of CMS Model of Care (MOC) requirements as it pertains to NCQA standards. The Clinical Program Manager, Principle will report to the Director of Care Management. In this role you will provide oversight for the entire DSNP MOC Program and clinical programs, ensuring alignment with organizational goals and objectives.

Your Work

In this role, you will:

• Operate at a strategic business level to ensures projects/programs are in line with Blue Shield of California strategic goals
• Lead and manage the Model of Care steering committee and strategic initiatives related to MOC projects
• Consult with all levels including senior management, make recommendations, and influence decision-making
• Leverage cross-functional internal and external relationships to drive initiatives forward
• Plan and implement multiple and extremely complex projects/programs spanning across business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Lead initiatives to enhance the quality, efficiency, and effectiveness of clinical programs
• Assist with monitoring completion of regulatory activities
• Develop a program, integrated program plan, resource plan, contingency plan, and related project management artifacts
• Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
• Analyze program data and metrics to identify trends, opportunities for improvement, and areas of risk

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 10 years of prior relevant experience
• Requires excellent analytical skills, with the ability to interpret complex data and make data-driven decisions
• Requires 3-5 years Care Management experience in a health plan or other managed care setting
• In-depth knowledge of compliance and regulatory requirements, with specific expertise in MOC is desired
• Requires exceptional communication skills, both verbal and written
• Requires a valid California RN license

Pay Range:

The pay range for this role is: $ 136400.00 to $ 204600.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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