Your Role

The Population Health Management (PHM) Children's Services team oversees and directs the development, evaluation and implementation of new or changing health care programs and clinical review of medical services for the organization using the established and approved Blue Shield Medical Policies which align with nationally recognized standards. The Population Health Management (PHM) Children's Services Clinical Manager will report to the Director, PHM Children's Services. In this role you will responsible for program execution and drives medical program management for specific clinical programs. Responsible for inventory management, monitors team performance ensuring individual, team and compliance performance metrics are met. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building, and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Establishes operational objectives for department or functional area and participates with other managers to establish group objectives.
• Responsible for team, department, or functional area results in terms of planning, cost in collaboration with the PHM Children's Services Director.
• Ensures workflow procedures and guidelines are clearly documented and communicated.
• Interprets or may initiate changes in guidelines/policies/procedures.
• Responsible for developing and communicating established individual and team performance metrics
• Responsible for staff development, career planning, coaching and formal performance management
• May lead special projects/committees/task forces
• May require weekend and holiday work and other duties as assigned

Your Knowledge and Experience

• Bachelors of Science in Nursing or advanced degree preferred
• Requires a current CA RN License
• A minimum of 7 years' experience, including 3 years of management experience gained as a team leader, supervisor, or project/program manager
• Medi-Cal Clinical Review experience preferred
• A minimum of 2 years' experience with Children's Services program
• MSN, MHA, MBA preferred
• PHN, Certified Pediatric Nurse Practitioner preferred
• In-depth Knowledge of the Medi-Cal Program specific to CCS, DDS, EI/ES, EPSDT preferred
• In-depth Knowledge of the Medi-Cal Program in skilled and long-term care facilities preferred
• Demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation
• Demonstrated knowledge of CMS / DHCS protocols and requirements preferred
• Demonstrated understanding of NCQA / CMS / DHCS regulatory audit requirements preferred.

Note:

The pay range for this role is: $ 109120.00 to $ 163680.00 for California.

Pay Range:

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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