The Program Manager Clinical, Principal (Social Worker) will be responsible for collaborating with ACO partners to transform the way health care is delivered. Ensuring best-in-class care for high-risk patients, delivering on the Triple Aim (lower cost care, increased quality and increased member satisfaction) with a focus on clinical execution to drive and accelerate improvements in primary care for all patients. This role will report to the ACO Clinical Senior Manager.
Lead in the development, design and launch of innovative care models
Ensure strategic alignment and clinical integration across the ACO, including internal and external partners
Work closely with strategic partners to provide transformative direction and drive implementation of clinical initiatives to improve efficiency and quality
Collaborate with clinical counterparts on inpatient workflows and process redesign to decrease barriers and increase resource options to positively impact length of stay and successful inpatient discharges to lower level of care or home. Incorporate behavioral health and palliative care interventions where appropriate.
Assist in the evaluation and identification of opportunities of high risk clinics. Work with external partners in the design and launch of clinical programs focused on behavioral health initiatives, patient education, palliative care, medication assistance, and addressing financial barriers.
Partner with both internal and external clinical counterparts to create or redesign home care programs focused on ensuring care for members in need.
Partner with medical groups and hospitals on initiatives providing case management interventions designed to promote health, prevent disease, and address barriers to access health care. Incorporate behavioral health initiatives into care management and care transitions.
Responsible for day to day clinical process consultation, coaching, and data analysis of ACO and innovative value-based care models to support affordability
Demonstrate a collaborative approach and an understanding of existing resources and relationships between/among partner organizations while moving them toward constructive change
Lend expertise and provide Blue Shield of California’s perspective to ensure alignment on care model strategy
Work cross functionally with Blue Shield of California internal teams to provide support both ad hoc and recurrent on clinical initiatives
Exercise independent judgment in developing methods, techniques and evaluation criteria for obtaining results
Influence and participate in process change and implementation through remote and onsite methods. Onsite time with external partners required to build relationships and provide real time guidance and rapid cycle process improvement of programs
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.