Program Manager, Consultant, Network Transitions bei Blue Shield of California Group

Your Work

In this role, you will:

• Serve as a subject matter expert in managing provider termination processes to ensure alignment with operational execution requirements
• Support the preparation of internal stakeholder meetings to facilitate coordination of work associated with contract renewals
• Oversee and track deliverables and action items related to provider terminations, including project plan management and maintenance of up-to-date documentation
• Recognize the need for and lead workgroups comprising stakeholders from multiple levels to advance operational objectives related to network transitions, ensuring effective progress and successful completion of tasks
• Manage the Provider Termination Playbook, maintaining documented policies and procedures related to provider renewals and terminations, and collaborating with internal stakeholders to update processes as needed
• Partner with the Senior Manager, Network Operations to confirm that project scopes within the Network Transition team are consistent with business priorities
• Communicate timely and effectively with parties within the Blue Shield organization with the ability to educate others on complex disciplines
• Transform raw data sets into clear and understandable analytics, collaborating with Network Operations leaders to identify actionable insights
• Develop gap analyses and presents applicable solutions to the internal team
• Implements and executes strategic decisions made by Network Operations leadership to support network terminations and renewals.
• Develops and manages comprehensive operational dashboards that display work efforts, relevant information, and applicable timelines
• Works collaboratively with internal stakeholders to ensure teams have the necessary resources to maintain regulatory compliance, enhance member experience, and uphold network integrity
• Work with Sr. Manager, Network Operations to support the establishment of governance frameworks to strengthen accountability, transparency, and effective decision-making throughout network operations
• Contribute to a collaborative and partnership-driven culture by developing strong relationships with internal stakeholders to support shared organizational goals

Your Knowledge and Experience

• Bachelor’s degree in business administration, Healthcare Administration, or a related field is required
• Minimum of seven years of relevant experience in managed care operations, provider relations or provider contracting
• Previous experience in healthcare program or project management
• Technically proficient in Microsoft Office suite (including Word, Excel and PowerPoint) with ability to compile presentations for leadership and data sets
• Must be a critical thinker, detail-oriented, exhibit exceptional communication skills in writing and in-person while also having the ability to track performance and deliverables understanding
• Comprehensive knowledge of managed care risk contracts and the operational requirements involved in managing a provider network
• Proven capability to manage and prioritize multiple tasks and objectives simultaneously
• Skilled in handling highly confidential information and serving as a liaison between business leaders and various internal and external stakeholders.
• Demonstrated ability to build enduring, trustworthy relationships and effectively interact across all organizational levels, both internally and externally
• Able to collaborate and work strategically in a team setting with various professional, technical, and administrative staff, integrating resources in a timely and organized manner

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:

At Blue Shield of California and the Ascendiun Family of Companies, 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:

o   Member-facing and approved out-of-state roles remain remote.

o   Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o   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.

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.