Program Manager, Consultant - Member Experience

Job Description

Your Role

The Medicare Star Performance team is responsible for achieving sustainable Medicare Advantage and 4 Star performance . The Program Manager, Consultant - Member Experience will report to the Director of Medicare Star Strategy and Performance. In this role you will implement programs and processes designed to improve member experience within our Medicare Advantage delivery systems. You will also be responsible for leading market initiatives to address member perceptions and enhance Blue Shield of California performance on Consumer Assessment of Healthcare Providers and systems (CAHPS) and Health Outcomes Survey (HOS). This is a field based position and will require visits with assigned delivery systems in person.

Responsibilities

Your Work

In this role, you will:

• Actively engage leadership and staff at all levels within a provider group/medical practice setting to enhance the member experience
• Influence the development and implementation of programs that improve member experience
• Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities. Develop and deliver training programs within provider groups to increase awareness of behaviors and techniques that affect member experience
• Review program budget variance and scope change requests, and participate in the budget-resolution process
• Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
• Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives
• Identify best practices for achieving high performance on Consumer Assessment of Healthcare Providers and systems (CAHPS) and Health Outcomes Survey (HOS) measures, meeting provider groups/medical clinics where they are in their member experience journey; Collaborate with providers to create actionable strategies and process improvement plans targeting specific performance metrics
• Utilize and integrate CAHPS, HOS, and other predictive analytic data to assist organizations in improving performance and lead special projects and activities focused on CAHPS and HOS performance improvement
• Maintain awareness of industry regulations that impact CAHPS/HOS survey measures and incorporate them into strategic initiatives
• Analyze and interpret survey data to identify trends, solve complex challenges, and develop strategic plans in collaboration with provider groups to drive process improvements

Qualifications

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires 3+ years of experience in healthcare quality improvement, provider engagement, or Medicare Advantage performance initiatives
• Requires familiarity with CMS regulations and Medicare Advantage programs
• Requires a proven track record of leading successful provider engagement and member experience initiatives
• Requires experience in facilitating peer-to-peer learning opportunities among providers to drive innovation and continuous improvement
• Requires expertise in analyzing and applying survey data (CAHPS, HOS, NPS) to drive performance improvement

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.