Job Description

Program Manager, Consultant Member Experience

Your Role

The Medicare Star Performance team is responsible for achieving sustainable Medicare Advantage and 4 Star 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.

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

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 data and analytics: applying survey data (CAHPS, HOS, NPS) to drive performance improvement

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

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

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• 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.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

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.

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.

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