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Program Manager, Consultant

Blue Shield of CA
United States, California, Oakland
601 12th Street (Show on map)
Sep 23, 2025

Your Role

The Quality Improvement team is accountable for quality ratings and the organization, development, and execution of targeted quality improvement initiatives in support of commercial medical groups, hospitals, and affiliated providers and our Covered California and CalPERS membership. The Program Manager, Consultant will report to the Senior Manager, Quality Improvement. In this role you will be accountable to build relationships with internal and external stakeholders. To execute data improvement efforts, incentive strategies, and new improvement tactics to raise HEDIS, QRS, and CAHPS outcomes in partnership with select California providers. To do this, the Program Manager, Consultant is expected to coordinate with internal, cross-functional matrix teams, as well as with executive leadership and staff in external provider organizations. Additionally, the Program Manager, Consultant will perform with little oversight, being responsible for identifying root causes of identified problems, formulating new perspectives and innovative approaches to solve the problems.

Your Knowledge and Experience

  • Requires a bachelor's degree or equivalent experience

  • Requires at least 7 years of prior relevant experience

  • Strong interpersonal skills and demonstrated ability to build relationships in fast-paced environments

  • Previous project/program management and process improvement experience required and ideally experience with Agile/Lean philosophies and tools

  • Proven ability to drive quality outcomes in the face of resistance, to conduct complex negotiations, and to create and maintain structure

  • Requires clinical work or non-clinical work in healthcare with provider partners working on quality improvements through HEDIS, QRS, CAHPS, for better patient outcomes, required knowledge

  • Requires willingness and ability to perform a role in a high pressure, high expectation, results-driven environment

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