Job Description

Your Role

The Clinical Quality [Commercial Populations] team is accountable for the quality ratings achieved for the organization's Commercial populations, as well as the preventive care strategy and outcomes for Blue Shield of California's Commercial members. Clinical Quality also manages financial, multi-site, system, and transitions of care risks associated with Quality performance. The Program Manager, Principal (Coordinated Outcomes) will report to the Snr Manager/Director of Clinical Quality. In this role you will create and drive the improvement strategy for preventive care outcomes in coordinated pediatric and adult dental health, with a focus on multi-site care, coordinating care with medical, and emerging HEDIS measures of dental health outcomes and improvements. Additionally, in close partnership with department leadership, you will develop and implement the operational roadmap for care gap closure through the identification, project management and execution of data system improvements, member support interventions, or provider engagement strategies, including but not limited to education, support and remediation activities. Specifically, the role leads annual planning for quality/improvement/equity activities and negotiates resources, workplans and timelines to achieve HEDIS and CAHPS results, as well as state contract requirements related to preventive dental health services, follow up care following emergency care, and equitable health outcomes. The role is accountable for refreshing, executing and evaluating annual plans and strategies that cascade and scale to multiple teams and functions.

Must reside within 50 miles of the Oakland or Rancho Cordova office and be able to work a hybrid schedule (approximately 2 days per week / 8 days per month onsite).

Responsibilities

Your Work

In this role, you will:

• Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California strategic goals
• Consult with all levels including senior management, make recommendations, and influence decision-making
• Leverage cross-functional internal and external relationships to drive initiatives forward
• Plan and implement multiple and extremely complex projects/programs with a focus on dental health, spanning across business areas
• Determine key business, quality, and technical issues to stimulate rapid improvement within dental health networks, develop effective action plans in partnership with dental health aggregators and provider representatives and implement to successful conclusion
• Be responsible for planning and implementation of cross-functional quality improvement programs aimed at improving preventive dental health care, which will encompass multiple projects, initiatives, functions and specialties and include the evaluation/analysis of complex data, financial inputs as well as intangible variance factors
• Coordinate and oversee the delivery of ambitious targets across multiple internal and external project teams of 5 to 10 people, creating structure to coordinate parallel tracks of work and information for rapid decision making for stakeholders supporting dental networks, stakeholders and providers
• Drive care gap closure and health outcomes in partnership with dental health teams and at dental and primary sites of care through Clinical Quality units to maximize improvement and goal achievement
• Structure budget planning, evaluation and gaps specific to dental health integration as part of the annual budget cycle
• Project manage and execute annual strategies and execution cycles for new and ongoing member interventions, focused on use of preventive and emergency dental services, in collaboration with internal and external teams and Leadership

Qualifications

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires a minimum of 10 years of prior relevant experience
• Must reside within 50 miles of the Oakland or Rancho Cordova office and be able to work a hybrid schedule (approximately 2 days per week / 8 days per month onsite).
• Masters degree preferred
• Requires demonstrated knowledge of Quality Ratings Systems, including HEDIS, and CAHPS measurement. Experience building related dashboards/data systems preferred
• Requires a minimum of 5 years of demonstrated experience in dental health systems, dental networks, dental workflows and dental improvement initiatives
• Requires experience executing improvement initiatives within or with a California dental network, as well as experience executing member or provider engagement interventions in support of preventive care outcomes and improvement for a diverse member population
• Requires demonstrated experience with complex analytic modeling and operational planning in environments of rapid execution as well as demonstrated knowledge of strategic planning and multi-year project and program management
• Requires demonstrated ability to communicate complex ideas about dental networks, providers, business and quality models, in a manger that is simple and succinct, both verbally and in writing. This includes the ability to speak comfortably and extemporaneously to diverse audiences.
• Required to be capable of self-management and exhibit as a self-starter
• Required to have demonstrated experience and strong skills assembling presentations for executive audiences, including guiding teams to gather pertinent information, and navigating a variety of presentation formats for various audiences

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 office two days each week.

Must reside within 50 miles of the Oakland or Rancho Cordova office and be able to work a hybrid schedule (approximately 2 days per week / 8 days per month onsite).

About the Team