Your Role

The Sr. Manager, Governance, of Population Health Management will report to the Sr. Director of Population Health Management. This role will help establish a strong governance structure and ensure key Population Health Management functions related to regulatory submissions, performance metrics, business readiness etc. are tracking to expectations, and aligning well with enterprise-wide priorities. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Spearhead efforts to establish a strong governance structure around Population Health Management organization.
• Oversee and manage a team of Project/Program managers and Data Analysts to support the delivery of critical Population Health Management priorities
• Support business readiness activities to help stand-up/enhance Population Health Management architecture
• Collaborate with key matrix leaders and teams such as the Office of the Chief Medical Officer, Health Equity office etc. to develop a unified and cohesive vision for Population Health Management
• Design performance metrics in line with population health programming
• Analyze best practices for population management and generate ideas to improve operational efficiency within the Population Health Management organization
• Develop comprehensive updates for executive leadership addressing potential opportunities, risks, contingencies, and/or course direction recommendations
• Actively participate in the Population Health Management leadership meetings, providing insight and guidance on strategic initiatives, ensuring population health objectives align with the organization's overall goals.
• Accountable for performing quality control analysis on Population Health Management deliverables due to Department of Health Care Services and other regulatory bodies
• Provide year-round Audit readiness support to Population Health Management teams and assist with Corrective Action Plan remediation.
• Work collaboratively with compliance leaders to maintain compliance with all applicable federal, state, and local legal and regulatory requirements. Meet compliance requirements and standards
• Stay abreast on relevant local, state, and federal policies
• Any other assigned duties
• Coordinate with cross-functional teams, including Analytics, Care Management, Quality, and Network Management to leverage data insights and optimize outcomes

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 10 years of prior relevant experience in regulatory research and knowledge of Medi-Cal, relevant laws, regulations, industry standards and best practices. Including 4 years of management experience.
• Ability to provide highly complex in-depth analysis and interpretation of data related to member enrollment and eligibility, community health and health equity and provide insights to solve business problems preferred.
• Demonstrated expertise in navigating large and complex organizations and successfully managing relationship building dynamics and processes within a highly matrixed environment.
• Progressive project and/or program management experience and knowledge in leading and managing the execution of processes, projects and tactics within an area.
• Ability to understand strategies, generate ideas and follow through on tactical execution.
• Excellent analytical and problem-solving skills.
• Strong negotiation skills and ability to successfully interact with all levels of management.
• Knowledge of Health Insurance Operations and broad knowledge of the industry.
• Excellent interpersonal and communication skills and proven ability to work effectively and drive results with all organizational levels (consult with executives, collaborate cross-functionally with internal clients and coaching at all levels of the organization).

Pay Range:

The pay range for this role is: $ 136400.00 to $ 204600.00 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.