What are the responsibilities and job description for the Program Manager, Consultant - Group Medicare position at Blue Shield of California?
Your Role
The Medicare team serves members across the state of California, including a Group Medicare offering for clients looking to provide a Medicare solution to their retiring employees and dependents. The Program Manager, Consultant will report to the Director of Group Medicare. In this role you will lead matrix relationships within Blue Shield related to Group Medicare accounts to build infrastructure around the PPO product, including capabilities around member engagement, operations, and utilization management. Responsibilities also include leading governance process and ongoing oversight of Group Medicare capabilities and overseeing workstreams and deliverables to ensure Blue Shield delivers on Group Medicare quality, membership, and OI outcomes.
Your Work
In this role, you will:
- 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 - specific to Group Medicare to enhance the customer and member all experience
- Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives
- Be the trusted subject matter expert to internal and external customers by maintaining in-depth knowledge of Group Medicare regulations, including CMS guidelines and compliance requirements
- Utilize deep expertise of Group Medicare to anticipate the client needs
- Translate complex Group Medicare concepts into easy-to-understand materials for internal and external needs
- Support Commercial Account Executives who manage overall relationships with accounts and consultants, represent Blue Shield in final round bid interviews and ongoing client meetings to understand their needs and ultimately retain client accounts, may also lead open enrollment meetings for key accounts
- Consult with functional partners on Medicare line of business to drive member outcomes which result in meeting client’s goals and objectives while achieving corporate goals, and build out specific client outcomes to report-out to show our effectiveness in Medicare Stars and risk adjustment scores
Your Work and Experience
- Requires a bachelor’s degree or equivalent experience
- Requires at least 7 years of prior relevant experience, including direct work with Group Medicare Advantage products
- Requires experience managing or working with Group Medicare accounts and/or Account Management for Group Medicare accounts
- Requires deep understanding of CMS compliance requirements and Group Medicare regulations
- Requires exceptional presentation and communication skills addressing both client and retirees
- Demonstrated ability to work cross-functionally, influencing without direct authority
- Ability to identify and propose innovative solutions to meet the needs of clients and retirees
Pay Range:
The pay range for this role is: $ 109340.00 to $ 164120.00 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.
ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. 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 fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. 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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- 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:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:
Member-facing and approved out-of-state roles remain remote.
Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
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.
On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
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.
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.
Salary : $109,340 - $164,120
