Your Role The Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC), which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities. This includes auditing, corrective actions follow-up, and monitoring activities of our delegated partners. The Program Manager, Senior will report to the Sr. Manager, Credentialing Delegation Oversight. In this role, you will be managing several projects that involve the DO department, including management and tracking of regulatory audits, monitoring, reporting, and management of the delegated entities' sub-delegation population. You will be responsible for strategic alignment and integration across projects/programs, from initiation through delivery, in support of business unit process and administrative efficiency. Defining projects required to support programs and partners to ensure their implementation on time, within budget, and with benefits realized. 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:
- Validate Subcontracted Network Accountability and Network Adequacy Standards to ensure compliance with DMHC APL 25-019 Req. VI Annual Network Review Amendments
- Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation
- Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities
- 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 programs, projects, and initiatives
- Partner with business drivers to design, develop, deliver, and execute strategy to promote regulatory compliance
- Adjust or recommend enhancements in processes to solve problems or improve effectiveness of job area
- Assemble a project team, assigning and monitoring work of team members, and providing guidance and leadership
- Communicate with contacts typically within the department on matters that involve obtaining or providing information requiring some explanation or interpretation to reach agreement
- Act as the business unit liaison to corporate initiatives and projects, providing input into designing strategies for alignment with business unit goals and objectives
Your Knowledge and Experience
- Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
- Requires at least 5 years of prior relevant experience in a health plan, hospital, or healthcare organization
- Requires a solid understanding of project and resource management, strong business acumen, team focus, experience working in a complex project delivery environment, as well as an advanced understanding of an enterprise project and portfolio management tools
- Experience with accreditation processes and quality improvement initiatives related to credentialing is preferred
- Desired knowledge of credentialing delegation oversight operations
- Strong critical thinking, analytical, and problem-solving skills
- Strong attention to detail skills and the ability to identify discrepancies and compliance issues
- Strong interpersonal and communication skills, with the ability to work effectively with diverse teams and stakeholders
- Ability to manage multiple priorities and deadlines in a dynamic environment, demonstrating strong organizational skills
- Familiarity with healthcare regulations and compliance requirements is preferred
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 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.
Please click here for further physical requirement detail.
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.
