Your Role

The Utilization Management (UM) team manages Intake, Prior Authorization, and Concurrent Review for all BSC lines of business. The Program Manager, Consultant will report to the Sr. Manager, Business Systems Analyses. In this role you will be responsible for driving the implementation of strategic initiatives to achieve administrative and CoHC savings in alignment with UM financial targets.

Your Work

In this role, you will:

• Direct small-scale, complex programs and projects that may involve multiple internal/external stakeholders and vendors.
• Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products.
• Develop the program, integrated program plan, resource plan, contingency plan, and related project management artifacts.
• Validate financial forecasts and provide on-going reconciliation of resources and other related program expenditures.
• Monitor and analyze performance metrics to identify bottlenecks, recommend process improvements, ensure continuous optimization of the roadmap, and enhancing overall operational efficiency and productivity.
• Lead project update meetings, hosting discussions to align teams and track progress towards resolution, and acting as primary point of contact for escalations, barriers, or issues.
• Manage UM operational readiness for critical programs to prepare business constituents to successfully adopt technical, compliance, and operational changes.
• Draft business cases for funding interventions, including defining the value proposition, quantifying performance gaps, and identifying potential opportunities and benefits.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience.
• Requires at least 7 years of prior relevant experience.
• Minimum of 4 years' experience leading programs/projects within a health plan is highly preferred
• Track record in driving multiple and concurrent projects/programs to completion and in complex and cross-functional environments.
• Excellent analytical and problem-solving skills.
• Must be detail-oriented, organized and can perform work independently.
• Healthcare industry knowledge and proven understanding of critical metrics within the healthcare industry preferred.
• SAFe 6 Agile PO/POPM experience preferred.

Pay Range:

The pay range for this role is: $ 109120.00 to $ 163680.00 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.