Sr. Director, Clinical Quality

Job Description

Your Role

Reporting to the VP, Quality, the role of the Sr Director is critical to the success of Blue Shield of California and the Clinical Quality department in realizing its goals and objectives. This individual will play a key role as part of the Quality team in delivering and collaborating on all aspects of quality outcomes. Responsible for the performance of all quality rating systems and for the development of strategic plans and programs to support continuous quality improvement. Developing, assessing, and delivering partnering on interventions, policies, and procedures at all levels and with critical operational departments to ensure quality programs will meet or exceed guidelines or requirements.

Responsibilities

Your Work

In this role, you will:

• Working with the VP, Quality, build out a detailed strategy to execute on multi-year quality plans which may include unique strategies for ACO, HMO, PPO and Medi-Cal delivery models. The quality plans will include staffing needs, infrastructure development, and partnering with other parts of the organization
• Manage a team of direct reports including several critical leaders and teams which deliver critical quality programs, models and operations
• Act as thought leader within BSC on methods to change member health behaviors and physician practice style that impact and improve quality outcomes
• Represent BSC on Quality at conferences and in statewide and national initiatives, and with state and federal regulators as necessary
• Evaluate and evolve current quality improvement and pay for performance programs using technology, member engagement strategies, partnerships with providers, incentives and other methods
• Partner with other BSC teams to enhance and customize programs to populations of members and providers
• Implement quality programs regional network specific strategy by working with internal and external organizations to disseminate and improve quality initiative uptake
• Develop and oversee provider incentive programs. Evaluate success of the programs and adjusting annually to drive outcomes.
• Oversee Medical Record Review and abstraction strategy and process
• Evaluate and Report Performance on Quality and Member Experience. Conduct program evaluations to inform revisions and refinements to interventions
• Ensure regulatory compliance and oversee audits

Qualifications

Your Knowledge and Experience

• Minimum of 10 years of relevant experience required including 8 years of management experience
• Bachelor's degree required in Nursing, Public Health, or other related field
• Master's degree in relevant field preferred
• Requires in-depth knowledge of quality, and change management processes
• Prior experience with total quality management, continuous quality improvement, and six sigma or lean methodology
• In-depth knowledge of NCQA, HEDIS process and specifications
• Ability to deliver a multi-year quality strategy

Pay Range:

The pay range for this role is: $190,410.00 to $285,670.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

About the Team

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. 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 fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. 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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• 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:

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
  
  • Member-facing and approved out-of-state roles remain remote.
  • Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
  • 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.
• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

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.