Vice President, Clinical Quality

Vice President, Clinical Quality The Vice President, Clinical Quality leads the Quality Management function within Blue Shield of California, overseeing the development and execution of clinical quality strategy across ACO and non‑ACO networks. The role reports to the Chief Health Officer and is responsible for providing clinical oversight of provider performance and ensuring compliance with all regulatory requirements. Location: California – the position can be based in any of our California offices. Responsibilities Lead the Quality Team Direct reports: Senior Director, Quality Management; Senior Director, Medicare Star Strategy; Director, Quality Analytics; Senior Project Manager; Senior Business Manager; Communications Manager; Executive Assistant. Serve as Medical Director for Quality Develop, document and implement the Blue Shield of California Quality Program, including setting the quality strategy and articulating the program to stakeholders. Conduct annual program evaluations to assess effectiveness and identify improvement opportunities. Lead Clinical Performance improvement for HEDIS, CAHPS, and Medicare Stars, with strategy, interventions, data collection, and program oversight. Oversee credentialing and re‑credentialing processes. Ensure quality of vended programs such as disease management, wellness, and behavioral health. Develop, implement, and operate data and analytics for Healthcare Quality Assurance (HCQA). Review and approve quality‑related clinical guidelines. Lead the Potential Quality Issues (PQI) program and regulatory oversight responses. Lead accreditation efforts for NCQA and URAC, supporting the organization to meet standards. Staff the Board Quality Improvement Committee. Represent Blue Shield of California in external quality collaborations such as the PBGH. Qualifications Education/Credentials Medical degree (MD or DO). Active, unencumbered license; California license preferred. Required Experience 7‑10 years in managed care, including management/leadership experience and quality management. Preferred Strong familiarity with California managed care marketplace. Prior experience with Blue Shield plans. Five years clinical experience. Knowledge & Skills People leadership skills. Ability to execute cross‑functional projects in a complex environment. Excellent verbal and written communication, with ability to speak to diverse audiences. Skill in explaining clinical and operational information clearly to non‑technical audiences. Strong quantitative and analytic skills with claims and clinical data. Excellent interpersonal skills, active listening, emotional intelligence, and situational adaptability. Negotiation and creative solutioning skills. Working knowledge of Microsoft Office (Outlook, Word, Excel, PowerPoint). Additional Requirements Must reside in California and be able to travel frequently. #J-18808-Ljbffr Blue Shield of California