Program Manager, Senior

Your Role

The Clinical Quality Analytics team oversees clinical quality measurement, HEDIS reporting, and related data and audit operations that support quality performance, accreditation, and regulatory requirements. Reporting to the Director of Clinical Quality Analytics, the Senior Program Manager will lead the planning and execution of annual HEDIS audit operations. This role serves as the primary operational liaison to external HEDIS audit firms and drives timely completion of audit roadmaps, information requests, onsite activities, and cross-functional deliverables.

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:

• Lead planning and execution of annual virtual HEDIS onsite audits, including agendas, scheduling, participant preparation, evidence coordination, meeting facilitation, action-item tracking, and timely closure of follow-up requests.

• Serve as the primary operational point of contact for external HEDIS audit firms; coordinate secure exchanges of data and documentation, clarify requests, establish response owners, and monitor the quality and timeliness of submissions.

• Own coordination and completion of the annual HEDIS audit roadmap and integrated workplan, establishing milestones, accountable owners, dependencies, decision points, and escalation procedures.

• Partner with HEDIS reporting, Clinical Quality, data analytics, technology, compliance, and other stakeholders to maintain audit readiness, resolve issues, and deliver commitments on schedule.

• Coordinate supplemental data source submission and audit support activities, including communications with internal and external submitters, documentation collection, and tracking of validation and evidence requests.

• Maintain transparent audit status, deliverable, risk, and issue tracking; provide concise leadership updates, recommend corrective actions, and proactively escalate barriers requiring decisions.

• Improve repeatable audit processes, templates, documentation controls, and cross-functional communication to strengthen readiness and reduce avoidable rework.

• Other duties as assigned.

Qualifications

Your Knowledge and Experience

• Bachelor’s degree or high school diploma/GED with four additional years of relevant experience in lieu of a degree.

• At least 5 years of prior relevant experience in program or project management experience, including ownership of complex cross-functional deliverables, milestone tracking, risk management, and stakeholder communication.

• Solid understanding of project and resource management, business acumen, and experience working in complex delivery environments; familiarity with enterprise project or portfolio management tools.

• Strong analytical, problem-solving, organizational, and written and verbal communication skills; ability to independently drive action and influence stakeholders without direct authority.

• Experience with HEDIS reporting and NCQA HEDIS compliance audits, particularly serving as a liaison to external HEDIS audit firms, strongly preferred.

• Experience coordinating virtual HEDIS onsite audits, audit roadmaps, audit information requests, and secure data exchanges preferred.

• Knowledge of health plan clinical quality operations, supplemental data source processes, and audit documentation practices preferred.

• PMP or other relevant project management certification preferred; not required.

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

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.