JOB DESCRIPTION
Your Role

The Utilization Management team manages prior authorization and concurrent review for all BSC lines of business. The Sr. Manager, Business Process Management will report to the Sr. Director, Utilization Management. In this role you will lead transformational business changes across the Utilization Management function, develop and manage analytics portfolio, and lead compliance readiness strategy and activities across Utilization Management departments . 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.

Your Work

In this role, you will:

• Formulate and execute the Blue Shield of California business strategy to establish key elements of and operational plans with measurable contribution towards the achievement of enterprise results
• Support the development of strategic plans and strategic project portfolios
• Develop strategy and delivery of analytics portfolio in support of business processes
• Lead audit readiness strategy and activities for all Utilization Management departments
• Own regulatory and internal reporting development and submissions
• Lead the development of customer-based metrics, process portfolio goals and annual roadmaps with multi-functional horizontal teams across Blue Shield of California
• Partner with multiple departments in setting up and coaching organic improvement projects within the lean sigma community of practice
• Drive external benchmarking and customer research to establish program goals and strategies
• Develops new operating models, policies, products and capabilities using systems thinking, in support of the enterprise strategy that will have impact on the achievement of improved customer experience and/or administrative efficiencies.

QUALIFICATIONS
Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Preferred certification in Lean/Six Sigma black belt or Certified Quality Manager
• Requires at least 12 years of experience leading BPM/continuous improvement activities from ideation through execution (internal to a company, or as an external consultant)
• At least 4 years of experience in management
• Proficiency in healthcare regulatory requirements and related processes
• Expert level knowledge in analytics deployment and utilization in support of business strategy
• Expert level knowledge in project portfolio management and organizational change management
• Expert level knowledge and skills in variety of process improvement and design techniques, and project management
• Mastery of strategic thinking, financial analysis and management, and cross-functional leadership and collaboration

Pay Range:

The pay range for this role is: $ 136400.00 to $ 204600.00 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 truly 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 comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – 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.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.