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Senior Manager of Medi-Cal Member Services Quality and Compliance Team

Company: Blue Shield of California
Location: Monterey Park
Posted on: July 26, 2022

Job Description:

Senior Manager of Medi-Cal Member Services Quality and Compliance 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! Your Role The Medi-Cal Customer Care Member Services team is responsible for servicing all Medi-Cal inquiries. This includes all inbound calls and correspondence, processing all return mail and supporting all outbound efforts . The Senior Manager of Medi-Cal Member Services Quality and Compliance team will report to the Director of the Medi-Cal Member Services team . In this role you will be responsible for quality and compliance measures, as well as reporting. The role will require cross functional liaison to address findings, identify opportunities for improvement and own quality improvement actions plans. The role will requires the individual to ensure all policies and procedures (P&Ps) are up to date and meet current and / or new regulatory requirement . As part of leading on compliances, this role will be required to ensure the department is audit ready and lead on all audit requirements being met for at least a twice-yearly audit. Finally, this role will be responsible for leading all Medi-Cal RFP readiness activities. Support all growth efforts in the call center to ensure the call center can support the expected growth and remain complaint throughout. -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: --- Be responsible for multiple team(s), department(s) or functional area(s); drives results aligned with planning, cost management and methods
--- Foster a great place to work by clearly communicating mission, vision, goals, roles, and expectations for team members; recognizing top talent and team achievements; building successful working relationships across the organization; ensuring a safe and healthy work environment; delivering the tools, time, and talent needed to succeed
--- Own the budget management, resource management, process improvements, and technology changes for the team(s), department(s) or functional area(s) within purview of this role
--- Develop and implement annual budget
--- Manage several related projects, often with the intention of improving the organization's performance
--- Ensure 100% of P&Ps remain up to date with all current and new regulatory requirements
--- Manage the performance of the quality team, report on results and maintain quality action plans
--- Meet all quality and compliance measures set for the team
--- Ensure call center team is ready and compliant will all audit requirements
--- Deliver 100% of RFP growth requirements for the member services team Your Knowledge and Experience --- Requires a bachelor's degree or equivalent experience
--- Requires at least 10 years of prior relevant experience, including 4 years of management experience
--- Medi-Cal regulatory requirements
--- Oversight of quality teams and owning / delivering quality action plans
--- Experience in working with cross functional teams to deliver shared goals
--- Experience of leading on audits and presenting to regulatory auditors
--- Project management skills to organize call center initiatives

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 Additional Information

  • Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. 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. " 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.
    COVID Vaccine Policy
    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 federal contractor and 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.
    *If the role you---re applying for is deemed an ---Essential Role,--- the Company has already determined that essential functions of the role can only be performed in Blue Shield of California offices or in the field. To protect the health and safety of our employees, business partners, and members, employees in Essential Roles must be up-to-date on COVID vaccination.
    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.
    • Requisition ID: 22002IB
    • Posting Date: Jul 14, 2022
    • Schedule: Full-time My ProfileCreate and manage profiles for future opportunities. Woodland Hills, California, United States of America Monterey Park, California, United States of America Rancho Cordova, California, United States of AmericaIf you havea disability and need assistance applying for a position with Blue Shield of California,call RehabWest, Inc. at (760)759-7500.

Keywords: Blue Shield of California, Monterey Park , Senior Manager of Medi-Cal Member Services Quality and Compliance Team, Executive , Monterey Park, California

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