Program Manager, Principal – Portfolio Management

Job Description Your Role The Portfolio Management team is responsible for supporting all HQA functional areas to meet their strategic and tactical goals. The Principal Program Manager will report to the Senior Director, Portfolio Management. In this role you will lead complex strategic healthcare initiatives focusing on improving healthcare quality, affordability, and member satisfaction. Key duties include complex program and process planning, implementation, and maintenance, operational process analysis, and medical policy review and maintenance.

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.

Responsibilities Your Work In this role, you will:

• Operate at a strategic business level to ensures projects/programs are in line with Blue Shield of California strategic goals
• Consult with all levels including senior management, make recommendations, and influence decision-making
• Leverage cross-functional internal and external relationships to drive initiatives forward
• Plan and implement multiple and extremely complex projects/programs spanning across business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Develop and maintain data driven strategy and operational reporting process in support of the Blue Shield prior authorization function. Analyze data, build control reporting, and communicate changes to all levels of the BSC enterprise
• Use data to assess operational performance, identify trends, and guide decision-making
• Drive initiatives that lead to better clinical outcomes, cost reduction, and member/provider satisfaction
• Contribute to HQA artificial intelligence strategy and make recommendations on areas of potential implementation
• Support evolving HQA portfolio and vendor strategy

Qualifications Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 10 years of prior relevant experience
• Requires a minimum of 8 years of demonstrated experience in healthcare operations working for a managed care organization
• Requires a minimum of 5 years of intermediate to advanced experience with program and project management
• Requires intermediate to advanced experience with SQL and MS Excel
• Experience with healthcare regulatory research and interpretation preferred
• Experience with healthcare code sets (CPT/HCPCS/ICD/DRG, etc.) preferred

About The Team 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.

Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility – providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• 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.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

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.