Hybrid Vision Director at Blue Shield of California Group
Blue Shield of California Group · Rancho Cordova, United States Of America · Hybrid
- Senior
- Office in Rancho Cordova
Your Role
The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Vision Director will report to the Medical Director, Operations. In this role you will provide leadership and guidance on vision program specialty for Blue Shield of California.
The Vision Director provides clinical expertise and consultative support to the organization related to vision. They are responsible for consulting and advising on care management, population health management and all other appropriate areas. Moreover, the Vision Director meaningfully contributes to the Blue Shield priorities and transformative initiatives that continue to improve the health and wellbeing of Blue Shield of California members. You will also provide direction and leadership in compliance with state and federal laws and regulatory requirements related to vision specialty.
*Please note that this is a Part-time role with a flexible, but fixed schedule.
Responsibilities
Your Work
In this role, you will:
- Provide Clinical oversight of vision specialty program and vision services vendors
- Establish a utilization matrix and provide an annual review of vision benefits. Ensure medical and vision integration for utilization management and care management.
- Serve as a vision thought leader within the organization and act as subject matter expert and advisor for product strategy, emerging technology trends, public policy, and mandates.
- Serve as the primary representative and as an active participant in Compliance Committee, Vendor Partner Quality Committee, Joint Operation Committee meetings, and other meetings or industry-related events as appropriate.
- Drive regulatory compliance adherence and leads corrective action efforts with vendors and medical operations teams.
- Complete assigned vision services clinical reviews on Appeals and Grievances within compliance standards and provide recommendations based on appeals, grievances, and dispute trend
- Attend other meetings or industry related events as appropriate
- Attend mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class
- Comply with local, state, and federal laws, statutes and regulatory requirements related to vision plan services
- Contribute content regarding vision marketing collaterals and draft and author vision articles on behalf of BSC
- Any other assigned duties
Qualifications
Your Knowledge and Experience
- Doctor of Optometry (OD) degree
- Active, unrestricted Optometry license in the state of California required
- Maintain Board certification in Optometry through American Board of Optometry (ABO)
- Minimum 5 years direct patient care experience post residency
- Completed Optometry residency training
- 5 years’ experience in managed care that can contribute to utilization management, case management, and/or quality improvement activities or other health care administrative operations at the IPA or health plan level
- Knowledge of Medicare, California statutes and regulations including DMHC. Understanding of NCQA accreditation standards preferred
- An ability to work independently to achieve objectives and resolve issues in ambiguous circumstances
- Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communications
- Strong collaboration skills to effectively work within a team that may consist of diverse individuals who bring a variety of different skills ranging from medical to project management and more
- Excellent written and verbal communication skills
- Excellent analytical, time management and organizational skills
- Proficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint
About Company
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.
