Program Manager, Consultant - Committee Oversight

Job Description

Your Role

The Clinical Operations Oversight team is responsible for managing key and critical health plan program functions and processes. The Program Manager, Consultant will report to the Senior Manager, Quality Governance. In this role you will be responsible for the coordination and implementation of the overarching clinical operations committee structure and governance, and ensuring the readiness of related documentation, which may be used as evidence of operational oversight compliance efforts. The Program Manager, Consultant will manage the creation and maintenance of a tracking and monitoring mechanism for all committee administrative activities and ensure clear documentation and ongoing monitoring of committee scope and participants.

Responsibilities

Your Work

In this role, you will:

• Provide overall program leadership, guidance, and manage all aspects of the Clinical Operations Oversight committee governance program, including definition of committee regulatory requirements (TAGs, NCQA Standards, etc.), initial and annual validation that each committee meets regulatory needs and requirements, standardization of committee charters, business case creation, and implementation
• Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities
• Review and suggest program budget, and once approved, manage variance and scope change requests, participate in the budget-resolution process, and manage compensation for external committee participants including determination of standard payment for committee participation, proposing structure for payment, and processing payments on an ongoing basis
• Manage external participation in committees including standardization of external committee agreements (disclosures agreements, etc.), distribution and collection of established agreements, determining optimal method to check licensure verification against requirements on an ongoing basis, and determining parameters regarding length of participation and conflicts of interest
• 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 involved in committee program operations, while providing technical expertise in planning, execution, and leadership, projects, and initiatives
• Create comprehensive corrective action plans to address identified deficiencies related to regulatory requirements; works with business owners to mitigate potential risk areas
• Ensure required documentation, data and action plans are collected from business owners, and as needed, prepared for submission to internal and external agencies, as appropriate
• Work to ensure a cohesive approach to quality is maintained between business units and lines of business as related to NCQA and Regulatory requirements. Recommend timing and communication of new best practice to internal and external participants
• Partner with Clinical Operations Oversight team members and other business owners to create, conduct and communicate findings of risk assessment activities aimed at closing operational deficiencies. Works with business owners and advises on closing such gaps
• Develops reports for leadership to understand ongoing compliance, gaps, and risks, as requested, including establishment of an annual review of committee adherence and effectiveness

Qualifications

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience, including in health plan or managed care
• Requires experience leading, guiding, and managing complex non-technical programs
• Requires ability to understand and interpret regulatory standards, such as TAGs and NCQA Standards
• Requires excellent communication skills, both oral and written
• Requires demonstrated investigative, problem solving, critical thinking and assessment skills
• Requires proficiency in use of PC-based software programs including Microsoft Word, Excel, PowerPoint, Outlook, and SharePoint with strong typing skills
• Committee governance and regulatory compliance strongly preferred
• Demonstrated experience in cross-functional operational improvement activities strongly preferred
• Strong organizational skills required; project management experience strongly preferred

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About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• 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 and the Ascendiun Family of Companies, 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:

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o 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.