Program Manager, Consultant (Clinical Quality)

Blue Shield of California•Woodland Hills, CA

About The Position

Your Role The Clinical Quality team manages projects to support the Medicare Stars – HEDIS Program. The Program Manager, Consultant will report to the Sr. Manager, Program and Project Management of Clinical Quality. In this role you will lead mid-size and complex projects and manage assigned provider groups while maintaining all project management information including timelines, resources, issues, scope, and other related project activities. This position works closely with the Medicare Stars Provider Engagement team and key stakeholders to achieve and sustain a higher performance in Medicare Star Ratings. 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. Responsibilities Your Work In this role, you will:

Requirements

Requires a bachelor’s degree or equivalent experience
Requires at least 7 years of prior relevant experience
Knowledge of Medicare Star Program requirements required
HEDIS quality improvement experience required
Demonstrated project/program management experience required
Intermediate to Advanced level of proficiency with Microsoft Power Point, Excel

Nice To Haves

Lean/Six Sigma/Performance Improvement training preferred

Responsibilities

Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation
Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities
Review program budget variance and scope change requests, and participate in the budget-resolution process
Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives
Track and manage policy changes to the Medicare Star program and keep executive sponsors and key stakeholders well-informed of the changes and impact. Also, responsible for working with key stakeholders to execute action plans that comply with new changes.
Acting liaison and subject matter expert on CMS communications
Ensures project goals and objectives are accomplished within designated timeframes and budget constraints. Also, regularly informs executive sponsors and key stakeholders of project status.
Train and mentor department coordinators and administrative staff to assist in project management, if appropriate.
Collaborate with key stakeholders to identify gaps, barriers and opportunities for improvement, and develop and implement enhancements that align with our critical few goals and glide path high performance.
Educate and work with external partners and participating practices as needed to identify innovation opportunities and adopt Star-related improvement actions.