Your Role

The Medical Care Programs team is responsible for managing programs vendor-delivered programs to manage care and deliver benefits for our members. The Program Manager, Consultant will report to the Senior Manager, Select Benefits and Utilization Management. In this role you will provide clinical support for prior authorization for advanced imaging, spine surgery, interventional pain, and oncology. You will be a member of a small team responsible for managing the vendor(s) that deliver these services, driving value, managing performance, and maintaining regulatory compliance.

Your Work

In this role, you will:

• 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
• Participate in RFP's and vendor contracting
• Oversee delivery of services by vendors
• Perform, monitor and sustain compliance activities to ensure audit readiness at all times
• Be accountable for select performance outcomes, particularly in reducing cost of health care and improving member and provider experience
• Monitor performance, identify issues, and drive resolution

Your Knowledge and Experience

• Requires a bachelors degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Clinical experience required
• Health care or health plan experience desired
• Program, project, or vendor management experience desired
• Analytical, problem solving, communication, and presentation skills required

Pay Range:

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