Sr. RN Program Manager

Helping make health care for Californians easy, accessible and reasonably pricedis a great calling. Knowing that your company has channeled over $100 millionback into California communities and will continue to do so is flat outuplifting. Join the hardest working, not-for-profit health plan in Californiaand be part of the solution.

Blue Shield of California (BSC) is a long-established health care firm which isembarking on a major program to reengineer its core business and to modernizethe technology that supports it. Medical Payment Policy Management strategy andintegration of the Legacy Modernization program will provide the key technologyand business processes which are fundamental to delivering on the firm'sstrategies for future growth.

The Senior Program Manager provide clinical strategic and tactical consultationfor operational redesign and business process engineering for the Medical PolicyManagement, LM integration, Quality/Accreditation policy/payment compliance,Dashboard measurement design, and other strategic imperatives in HCS. Thisposition will be focused on designing and installing business solutions withinHCS and spanning across Customer Service, Claims, Network Management, and Legal.

Responsibilities

Partners with the Legacy Modernization redesign team and key stakeholders todefine, build and implement our future state operating model

Planning: Defining and validating project scope, creating project plans andschedules, selecting and applying standards, assessing risks, defining metrics.

Support the overall implementation of strategic and tactical business solutions.

Partners with the technical and configuration teams to arrive at future stateoperating models and detail requirements process/policy/procedures

Partner with the integrated detailed design team of key constituents from everyfunction associated with HCS.

Accountabilities include:

A) Creation of a new end-end process with associated artifacts (process maps,policies, procedures, desk level references etc.)

B) Facilitate and collaborate in cross-functional teams and specific individualsto design scalable business solutions.

C) Integration of change management techniques to ensure audience moves throughthe change cycle: awareness, understanding, acceptance, and adoption.

D) Manage implementation plans to roll out the new processes.

Responsible for department results in terms of planning, cost and methods.



Communicates expectations and results on a regular basis; maintains goodcommunications within unit.

Bachelor´s degree and eight to ten years of consulting, business analysis,program/project management experience or equivalent combination of education andexperience.

Demonstrated leadership and ability to interact with all levels including seniormanagement and influence decision-making.

Must work independently and have strong communication writing and presentationskills.

Must possess excellent time management and organizational skills and be able tohandle multiple high profile projects.

Be able to create and review project proposals or plans and set projectobjectives.

Manage scope and scope change requests.

Complete cost/benefit analysis and/or Business Cases.

Develop budgets and timelines to support quality initiatives and programs. Planand direct timelines and budgets.

Monitor projects from initiation through delivery and monitor for continuousimprovement.

Identify and develop contingency plans to mitigate and address risks.

Takes responsibility for benefits realization and meeting milestone and budgettargets.

Be able to communicate with and influence internal and external stakeholders onproject steps and objectives.

Provide input into designing strategies to align solutions with business unitgoals and objectives.

Preferred Skills:

Masters or equivalent degree in a science-, social-science-, health careadministration-, engineering-, or business-related field strongly preferred

Consulting experience with change management, business process redesign, andplanning expertise is a plus.

Healthcare Insurance industry experience (Insert Claims, HCS, NM) stronglypreferred

Six Sigma/PMI Certification desirable



Bachelor's degree; active California RN license; equivalent combination ofeducation and experience.


Proficiency in clinical documentation and working knowledge of computers andrelated software applications.

Demonstrated leadership, project management and program evaluation skills andability to interact with all levels including senior management and influencedecision-making.

Comprehensive knowledge of discharge planning, utilization management andcommunity resources.

Strong supervisory, communication and negotiation skills.

Ability to interact with all levels including executive management and influencedecision-making.

Skill in planning, organizing, leading and effectively managing projects or teammembers in the performance of their duties.

Blue Shield of Califonia is an Equal Opportunity Employer.

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