Clinical Program Manager, Medicare Star Program

Blue Shield of California
Washington, DC
Jun 19, 2017
Jun 21, 2017
Full Time
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.Job Summary:The Clinical Program Manager has primary accountability for developing and managing end to end clinical programs within the organizational framework for the Medicare Star Program. Responsible for delivering results-oriented clinical solutions and is expected to coordinate with internal, cross-functional partners and external vendor partners to ensure timely execution of deliverables within budget to support the business unit strategy. Assist in defining strategic Star Program approach to enhance current relationships with key provider groups. Lead efforts to building a strong collaborative relationship with external provider group partners. Leads interdepartmental activities and may perform operational responsibilities. May be responsible for assembling a project team, assigning and monitoring work of team members and providing guidance and leadership. Scope & Responsibilities: Responsible for planning, execution and evaluation of large/complex program initiatives to improve quality performance in Medicare line of business with emphasis around the Star Program. Develops and monitors measurement strategies for large change and improvement initiatives. Manages program(s) from initiation/pilot phase through delivery/spread and monitors for continuous improvement. As part of a broader QI team, influences the business unit, strategies and objectives. Provides input into designing strategies for alignment with business unit goals and objectives. Establish / apply quality objectives, criteria, standards and levels using appropriate quality management methods, with stakeholder input (eg, key performance indicators, scope definition) Manages program(s) from initiation through delivery and monitors for continuous improvement. Participates cross-functionally in business planning to support business unit strategy. May assist in the planning and direction of budgets. Responsible for assembling the internal Star project team, assigning and monitoring work of team members and providing guidance and leadership. Knowledge of company products, functions, marketing and/or service policies and procedures. Serve as a quality expert with internal constituents to drive Star-related program development and outcomes success. Educate and work with external partners and participating practices as needed to identify innovation opportunities and adopt Star-related improvement actions Some travel is required

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