Director, Clinical Quality - HEDIS

Your Role

The Clinical Quality [Commercial Populations] team is accountable for the organization’s quality ratings, preventive and primary care outcomes for Blue Shield of California’s Commercial members, and financial risks associated with quality performance. The Director, Clinical Quality will report to the Senior Director, Clinical Quality. In this role you will be accountable for provider network quality performance within the capitated (HMO), fee-for-service (PPO), self-funded and specialty care networks. This includes accountability for designing and executing strategic roadmaps to achieve quality and financial targets, as well as managing a cross-functional, statewide team.

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.

This person is required to live within 50 miles of the Oakland, Rancho Cordova, Woodland Hills or Long Beach office locations.

Your Knowledge and Experience

- Requires Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
- Requires at least 10 years prior relevant experience achieving outcomes in HEDIS, CAHPS or other publicly reported quality ratings targets
- Requires 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
- This person is required to live within 50 miles of the Oakland, Rancho Cordova, Woodland Hills or Long Beach office locations.
- Master’s degree or equivalent in healthcare administration, public health, or a related field and Lean Six Sigma, or a comparable planning, strategy, program, or improvement certification preferred
- Requires experience within a California health plan or comparable regulated payer environment and applying structured change-management methodologies within the California healthcare system
- Requires demonstrated experience leading annual or multi-year planning in a complex, matrixed organization
- Requires at least 6 years’ experience implementing quality interventions for and with preventive care and behavioral health or dental providers
- Experience with health equity interventions within clinics, practices or medical groups preferred
- Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment as well as required travel within the state of California. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of the workday

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.