Program Manager Clinical, Principal (Registered Nurse)

Your Role

The Care Management Department, which oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of NCQA (National Committee for Quality Assurance) standards. The Clinical Program Manager, Principle will report to the Director of Care Management. In this role you will provide oversight for clinical programs, ensuring alignment with organizational goals and objectives.

Your Work

In this role, you will:

• Operate at a strategic business level to ensures 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 spanning across business areas

• Determine key business issues, develop effective action plans and implement to successful conclusion

• Analyze program data and metrics to identify trends, opportunities for improvement, and areas of risk.

• Assist with monitoring completion of regulatory activities

• Lead initiatives to enhance the quality, efficiency, and effectiveness of clinical programs.