Your Role

The Clinical Support team partners closely with providers currently utilizing the Primary Care Hybrid or Fee-for-Service Plus (FFS+) payment models, which are Blue Shield of California's (BSC's) flagship PPO pay-for-value models specifically designed for small primary care practices. These models aim to incentivize high-quality care and enhance outcomes for patients, making them critical components of our value-based care strategy. The Program Manager, Consultant role supports independent primary care practices in optimizing clinical quality and performance under these models. The Program Manager, Consultant will play a pivotal role in guiding practices to fully leverage the benefits of these payment structures, driving measurable improvements in patient care and practice efficiency.

Your Work

In this role, you will:

• Manage clinical aspects of the Primary Care Hybrid and FFS+ Payment Models from initiation through delivery and monitor for continuous improvement with a focus on clinical quality and resource utilization
• Educate and work with external partners and participating practices to maximize their performance on outcomes of the value-based payment models
• Plan and execute initiatives to improve quality performance within specific value-based payment models
• Conduct data analysis, including leveraging dashboards, Excel, and the Blue Shield of CA web-based value-based payment platform
• Serve as a subject matter expert to internal stakeholders as they drive HEDIS, utilization, member and provider experience outcomes success, as well as support external partners in creating actions plans to close care gaps
• Support external partners as they drive HEDIS, utilization, member and provider experience outcomes success as well as support external partners in creating actions plans to close care gaps
• Exercise independent judgment in developing methods, techniques, and evaluation criterion for obtaining results
• Participate in monitoring and evaluation of effectiveness of clinical support program

Your Knowledge and Experience

• Requires a Bachelor's degree or equivalent experience
• Master's degree or clinical licenses preferred
• Requires 7 years of experience in the related area
• Experience of at least 2 years working in a healthcare setting (Health Plan or Provider setting) is preferred
• Provider education experience on value-based payment models, HEDIS, or Medicare Stars is preferred
• Project management experience is preferred
• Clinical background (RN, MA, LVN, etc.) is preferred
• Knowledge of change management concepts and techniques is preferred
• Strong communication, meeting facilitation and presentation skills
• Experience working well in a team, fostering a cooperative and productive environment
• Proactive, solution focused mindset with demonstrated creative, analytical and problem-solving skills
• Proficiency in MS Outlook, Word, Excel, PowerPoint, Access

Pay Range:

The pay range for this role is: $109,120.00 to $163,680.00 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.

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