The ClinicalProgram Manager, Trio Rapid Improvement is responsible for the development and execution of targeted, quality improvement initiatives in support of the ACO medical groups, hospitals and affiliated providers. This includes the design and development of improvement initiatives, pilots, toolkits, spread plans and contract language. The incumbent also has accountability for aligning quality improvement initiatives with other lines of business (PPO, Medicare) and for ensuring that current and future QI programs align with long-term organizational strategies.
In a results-oriented environment, the clinical program manager will execute data improvement efforts, incentive strategies and new improvement tactics to raise HEDIS and CAHPS outcomes in partnership with select southern California providers. To do this, the Clinical Program Manager is expected to coordinate with internal, cross-functional matrix teams, as well as with clinical leadership and staff in provider organizations. The Clinical Program Manager will be responsible for participating in project teams and working with external vendors, assigning and monitoring work of team members and providing guidance and leadership to ensure timely execution of deliverables. This position may include limited accountability for managing budgets.
In partnership with the ACO team, the Clinical Program Manager will also be accountable for building strong, collaborative relationships with targeted provider organizations. Additionally, this position organizes interdepartmental activities and has some operational and ad hoc responsibilities.
Scope & Responsibilities:
Responsible for planning, execution and evaluation of large and complex program initiatives to improve quality performance.
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.
Becomes an expert in company quality initiatives, as well as the products, functions, marketing and/or service policies and procedures that support those initiatives.
Serves as a quality outcomes (HEDIS, CAHPS) expert with internal and external constituents
Educates and works with external partners and participating practices as needed to identify innovation opportunities and adopt improvement actions
Exercises independent judgment in developing methods, techniques and evaluation criterion for obtaining results.
May assist in the planning and direction of budgets and execution of expense monitoring.
May act as the business unit liaison to corporate initiatives and projects.
Nature of Supervision:
Provides guidance and leadership to and may supervise project consultants.
Ensures various team members provide high quality and cost effective services.
Demonstrates ability to work with and influence team members functioning in a matrix environment.
Demonstrates thought leadership, excellent project management skills, knowledge and experience with program evaluation and consulting skills.
Job Required Education/Experience:
Registered Nurse (RN, LVN, BSN), PA or Master’s degree (MPH, MHA, MSW) preferred; or equivalent experience
At least 5 years of experience or equivalent combination of experience and education.
At least 5 years of healthcare experience in Quality Improvement and Quality Management.
Experience with quality improvement/process improvement techniques required
Knowledge of HEDIS and accrediting body requirements (i.e.; NCQA or URAC) desired
Experience in the CA healthcare delivery preferred
Job Additional Education/Experience Key leadership competencies to include:
Strong ability to drive for results
Strong facilitator with demonstrated excellence in driving multi-disciplinary and cross-functional teams to consensus
Demonstrated ability to influence in a healthcare environment
Seasoned Critical Thinking
Ability to manage large, complex projects
Communication – the ability to summarize complex information succinctly, using QI methodology as a guide
Experienced in Change Management Processes, including Improvements and Redesign
Skilled at facilitating and growing Collaboration and Motivation amongst geographically disperse teams
Strong Interpersonal Skills and demonstrated ability to build relationships in fast-paced environments
Internal Number: 180028H
About Blue Shield of CA
At Blue Shield of California, we are helping people live their healthiest lives possible by working together in our communities to completely rethink and rebuild the way care works today. We’re creating a truly personalized experience that is in tune with all aspects of your life: mind, body and soul. We’re ensuring you get the best care by helping you stay healthy and happy. We’re using the latest technology that rivals how all other aspects of your life work and gets us to smarter, more precise diagnoses and decisions.
We are rethinking and rebuilding the way it works today. In order to jump start this transformation, we have created an innovation program within our Health Care Quality & Affordability function called Health Care Model of the Future where we will be piloting bold transformations in select ecosystems in California.
Blue Shield of California is recognizing the importance in investing in this effort to improve patient treatment while reducing overwhelming administrative burdens, freeing physicians to be doctors, rather than data entry technicians. We can, in this manner create personal 21st century care.
Join this team in our work to design and implement the Health Care Model of the Future. We can’t wait to meet you!