Program Manager Clinical, Senior

Program Manager Clinical, Senior

The Care Management team is looking for a strategic leader with Care Management experience who can help support our Population Health Management (PHM) Medi-Cal Care Management line of business. The Program Manager Clinical, Senior will report to the Director of Care Management. In this role you will monitor and drive initiatives for the Transitional Care Services (TCS) program that will improve care transitions, reduce avoidable readmissions, enhance post discharge follow ups, and ensure compliance with regulatory requirements. You will serve as liaison between TCS, contracted provider organizations, hospitals, and internal stakeholders to optimize workflows, strengthen partnerships, and advance an integrated, whole health care model.

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

In this role, you will:

• Direct small-scale, complex programs/projects that may involve multiple internal and external stakeholders
• Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
• Develop the program, integrated program plan, resource plan, contingency plan, and related project management artifacts
• Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan
• Lead continuous workflow optimization to improve efficiency, quality, and member outcomes.
• Support operational integration and optimization of Community Health Advocate (CHA) workflows to improve care coordination and member engagement.
• Serve as the point of contact for Independent Physician Associations (IPAs) and hospitals for TCS-related operational inquires.
• Represent TCS during Joint Operations Meetings, provider workgroups, hospital meetings, and cross-functional committees.
• Conduct routine audits of TCS cases to ensure compliance with regulatory requirements, documentation standards, and clinical workflows.
• Identify trends, gaps, and operational risks through case reviews and performance monitoring.
• Other duties, as assigned

Qualifications

In this role, you will need:

• Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree and completion of an accredited educational program that meets the requirements for the applicable professional license is required
• Clinical license within the state of CA required (RN, LVN, NP, PA, LCSW etc )
• 5 or more years of relevant experience in managed care, population health, care management, transitional care services, or healthcare operations required.
• 3 or more years of program management, project management, or operational leadership experience preferred.
• Experience working collaboratively with hospitals, IPAs, physician groups, and multidisciplinary team preferred.
• Knowledge of DHCS, CMS, NCQA, and Medi-Cal managed care requirements preferred.

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Blue Shield of California