Program Manager Clinical, Consultant (Small To Mid)

About the Role

The Commercial CMO Team provides clinical oversight for programs and processes that support members’ health care, reduce costs, and improve quality. The Program Manager Clinical, Consultant reports to the Director of Program Management, Clinical – CMO. In this role, you will analyze clinical and financial data to identify trends and opportunities to improve care and manage costs for employer-funded health insurance. You will lead projects to address these opportunities and develop presentations that clearly communicate clinical insights and recommended actions. Additionally, you will facilitate meetings with internal and external stakeholders and drive improvements in healthcare cost trends through both direct interventions and broader, system-level initiatives.

Our leadership model focuses on developing great leaders at all levels and creating opportunities for personal, professional, and financial growth. We seek leaders energized by creative and critical thinking, building high-performing teams, achieving results ethically, and fostering continuous learning.

Responsibilities

• Provide analysis, leadership, and guidance for a given line of business, including opportunity identification, business case creation, and implementation.
• Provide steady leadership amid uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model.
• Create presentations and manage meeting requests at a high level. Lead cross-functional meetings, foster teamwork, drive issue escalation and resolution, and promote collaboration across broad stakeholder categories.
• Collaborate with analytics, actuarial, and quality teams to develop, analyze, and distribute reports, and document program activities, interventions, and outcomes.
• Perform deep-dive analysis of high-cost claims, vendor-identified populations, and other defined groups, producing case studies, reports, and presentations.
• Organize and lead cross-functional meetings, fostering teamwork and collaborative problem-solving across diverse stakeholders.
• Facilitate cross-functional taskforces with specific cost-of-healthcare commitments.
• Research and recommend interventions; identify and drive improvements to significantly impact the cost of healthcare.
• Partner closely with analytics teams to develop, analyze, and distribute reporting.
• Liaise with analytic and cost-of-healthcare groups across the enterprise to compare trends, share knowledge, and measure outcomes.

Qualifications

• Bachelor’s degree or equivalent experience.
• At least 7 years of prior relevant experience.
• Current California LVN, RN, NP, or PA license.
• Familiarity with healthcare data and the healthcare delivery system in California; health plan or provider experience strongly desired.
• Strong organizational and/or project management skills, with a consistent ability to “self-start” and take ownership of end-to-end taskforce activities.
• Excellent written and oral communication skills, with the ability to facilitate cross-functional discussions, lead teams through influence, and drive actions and outcomes.
• Experience in cost-of-healthcare analysis, population health outcomes, and/or program evaluation desired.

Schedule

This role allows employees to work virtually full-time, however, employees will be expected to come to the office based on business need. 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 those in certain member-facing roles should work with their manager to determine in-office time based on business need.

Pay

Pay Range for California: $111,540.00 to $167,420.00

Pay Range for Bay Area: $125,736.00 to $188,728.00

Note: This range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Salaries are based on candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

About Us

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 healthcare 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 communities we serve.

Blue Shield is recognized as 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.

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 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.

Physical Requirements

Office Environment – roles involving part- to full-time schedule in an office environment. Based in our physical offices and work from home office/deskwork. Activity level: Sedentary, frequency most of work day.