Program Manager, Principal - Medicare PPO

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. 

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.

Your Role 

The Program Manager, Principal provides leadership and operational support to advance quality performance across clinical programs and contracted provider groups. This role drives the implementation, oversight, and continuous improvement of quality structures, processes, and outcomes necessary to achieve high performance in Medicare Stars, HEDIS, risk adjustment, preventive care, and value‑based care programs for a PPO product line.

 

This position partners closely with internal teams, including Clinical Quality, Medicare Stars, Product, IT, Finance, Population Health, Clinical Integration, and Medicare Operations—as well as external provider groups to ensure successful execution of quality initiatives and organizational goals.

 

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: 

• Provide overall program leadership, guidance, and management of mid‑size and complex quality improvement projects, including requirements gathering, business case creation, planning, execution, and implementation.

• Maintain all project management components including timelines, scope, risks/issues, resources, and stakeholder communication.

• Lead cross‑functional meetings, drive issue escalation and resolution, and foster collaboration across diverse stakeholder groups.

• Support and coach team members and internal project managers on project execution and improvement methodologies.

• Partner with organizational leadership to advance Population Health initiatives and multi‑specialty quality and value‑based care programs related to clinical quality, risk adjustment, care optimization, cost-of-care initiatives, and performance measurement within the PPO product line.

• Collaborate with operational leaders to execute against quality, care, and financial measures.

• Track performance across various program models (e.g., HEDIS, Medicare Stars) and coordinate stakeholders to identify gaps, barriers, and improvement opportunities.

• Oversee the production, interpretation, and dissemination of dashboards, analytics, and insights that drive performance improvement across provider groups and clinical programs.

• Analyze quality and quantitative data to identify trends, variation, and opportunities for improvement; guide stakeholders in developing effective action plans.

• Maintain and report quality performance for Medicare PPO product.

• Work with leadership to identify improvement priorities, establish annual goals, and facilitate performance improvement work utilizing Lean, Six Sigma, or other improvement methodologies.

• Coach leaders and clinic teams in the application of quality improvement tools, methods, and best practices.

• Coordinate the ongoing review, update, and communication of quality‑related policies, procedures, and workflows to support high performance and outstanding clinical outcomes.

• Maintain current knowledge of national and local public reporting initiatives, regulatory updates, and clinical quality standards that impact organizational performance.

• Manage complex relational dynamics within provider groups and external partners while educating Stars/HEDIS requirements and other quality‑related program expectations.

• Identify innovation opportunities and support adoption of quality improvement actions with external provider partners.

• Serve as subject matter expert and liaison for CMS and payer communications related to quality programs.

• Perform other duties as assigned.

Your Knowledge and Experience 

• Bachelor’s Degree or equivalent combination of education and experience.

• 10 years of increasingly responsible experience in healthcare quality, population health, or clinical operations.

• Demonstrated experience in project/program management.

• Experience with quality performance measures such as HEDIS, Medicare Stars, patient experience measures, and risk adjustment models in the PPO space or Fee for Service (FFS) space.

• Ability to interpret and use quantitative and quantitative data to drive improvement.

• Knowledge of quality improvement practices and methodologies.

• Lean, Six Sigma, or Performance Improvement training or certification.

• Intermediate to advanced proficiency with Microsoft Excel, PowerPoint, and other analytical/project management tools.

 

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.