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Senior Manager, Quality Improvement Job
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| Employer Name: |
SpiderID: 13964753 |
| Location: Woodland Hills, California |
Date Posted: 3/20/2025 |
| Wage: Negotiable |
Category: Insurance |
| Job Code: 17002EY-2191 |
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Job Description:
 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
All positions in the Quality Improvement team at Blue Shield of California support our mission: to ensure all Californians have access to high-quality health care at an affordable price.
The Senior Manager of Quality Improvement is responsible for health plan-wide oversight of clinical quality improvements for all lines of business in the Southern California geographic area. In a results-oriented, environment the Senior Manager is accountable for developing, implementing and monitoring a data-driven quality improvement strategy. Senior Managers are expected to drive system-wide improvements that impact member care and simplify processes.
The Senior Manager is accountable for setting priorities and will draw upon cross-functional teams within Blue Shield of California to achieve results. The individual in this role must be able to work within large, multi-disciplinary teams to monitor milestones and deliverables. The Senior Manager is expected to partner effectively with provider organizations to identify improvement opportunities, as well as to define specific goals and action plans. Additionally, the Senior Manager must be able to develop strong, collaborative relationships with statewide regulatory and community based organizations to define quality-oriented objectives. As a result of the scope and territory, it is anticipated that the position involves travel up to 50% of the time.
The Senior Manager oversees an inter-disciplinary, internal team's efforts to improve HEDIS, CAHPS and emerging quality measures in partnership with providers throughout Southern California. This individual enables the financial success of Blue Shield of California by managing an internal budget, by ensuring that multi-million dollar improvement initiatives are appropriately funded and by closely monitoring expenses. The team is also accountable for value-based incentives, and informs risk-sharing contract design. The role supports the ACO, PPO and HMO teams in the integration of quality reporting and implementation of clinical improvement initiatives.
Throughout the year, the Senior Manager is expected to assess results, dependencies, and barriers to execution. The position reports to the Director of Quality Improvement.
Scope and Responsibilities :
• Strategy: In collaboration with the Director of Quality Improvement, the Senior Director of Quality Management, and the Vice President for Clinical Quality, Network and Markets Support, the Senior Manager creates an all-encompassing, data driven improvement strategy for BSC's integrated, delegated, accountable care networks and small/individual physician practices. This includes comprehensive analysis of HEDIS, CAHPS, pharmacy and other applicable measures.
• The Senior Manager is accountable for monitoring business line strategy, team goals, and ensuring strategic alignment to BSC corporate goals.
• Regulatory:
o Works with senior management to ensure ongoing full compliance with formal quality improvement workplans and regulatory standards. Fulfills NCQA requirements related to quality improvement.
o Identifies and recommends corrective action on clinical and service quality issues to enhance compliance and overall plan performance in Quality.
o Creates a measure-by-measure plan for improvement in accreditation ratings.
• Analysis:
o Directs analysts in measurement and tracking of program effectiveness
o In partnership with the quality measurement and quality assurance teams, provides quantitative and qualitative insights to long-term strategy strategies
o Applies analytical techniques and provides recommendations using critical thinking and sound judgment.
• Quality Improvement: Plans, executes and evaluates complex programs and improvement initiatives using quality Improvement methodologies, tools and approaches.
• Internal and external partnership:
o Builds trusting relationships within a large organization and with providers to enable the delivery of services
o Works with external organizations such as the Integrated Healthcare Association, the Institute for Healthcare Improvement and the Blue Cross Blue Shield Association.
• Independence :
o Executes complex assignments where individual judgment is required in to resolve problems and make strategic recommendations.
o Exercise independent judgment when developing budgets, workplans and communications
o Demonstrates sense of urgency, initiative, responsiveness
• Performs other duties as assigned by management
Supervisory Responsibilities:
• Accountable for building a high performing team within the Quality department.
• This position will have accountability for improvements in PPO, ACO and HMO lines of business.
• This position will require up to 50% travel the first 2 years due to locations of provider offices and staff
• Effectively leads and manages a team to execute on strategic improvement plans. This includes managing RFPs, vendor contracts and work products, and collaborating with providers in the community.
• Ensures team has the ability to establish and meet deadlines
• Ensures team members have the skill sets to provide high quality, cost effective work products and is focused on individual team member development
• Demonstrates thought leadership and leads by example,
• Summarizes complex information succinctly; effectively communicates with senior executives
Qualifications:
• Bachelor's degree required, Masters degree preferred in health related field, or equivalent combination of education and experience
• Minimum of 5 years of experience in health plan environment with focus on quality and/or process improvement
• Minimum of 3 years management experience required.
• Must be willing to travel up to 50% to providers offices and staff.
• Knowledge of HEDIS and accrediting body requirements
• Demonstrated outcomes reliant upon project/program implementation, business process re-engineering and data analysis.
• Excellent organizational skills
• Strong computer skills; demonstrated mastery of all MS Office products (including Outlook, Excel, PowerPoint, Word, Internet Explorer)
Preferred
• Experience in California healthcare with both delegated models and small practices, or experience with integrated clinical delivery systems
• Experience managing, implementing and evaluating quality improvement programs and change management processes
• Knowledge of improvement methodologies such as Lean Six Sigma techniques.
• Skilled at facilitating geographically disperse teams
• Demonstrated ability to build relationships in fast-paced environments
• Financial/Quantitative Acumen
• This position will require up to 50% travel the first 2 years due to locations of provider offices and staff
Job Additional Education/Experience Key leadership competencies include:
o results-driven
o strong written and verbal communication skills
o strong work ethic
o experience with cross-team collaboration and work re-design
o motivational relationship builder
o financial/quantitative business acumen
o seasoned critical thinker
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: Blue Shield of California |
Company Type: |
| Company: Blue Shield of California |
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