<strong>Job Description</strong><br><br><strong>Your Role</strong><br><br>The Medi-Cal Behavioral Health Services team drives operational excellence and regulatory compliance for the office of the Chief Medical Officer for Blue Shield Promise Health Plan. The Medi-Cal Behavioral Health Program Manager, Consultant will report to the Director of Clinical Access Programs & Medi-Cal Behavioral Health Services. In this role, you will lead cross-functional initiatives to improve behavioral health outcomes, collaborate with stakeholders to ensure regulatory and audit readiness, manage committee administrative activities, and drive continuous improvement in program operations. This role demands strong project management skills, coordination of cross-functional teams, coordination of large interdepartmental meetings, and expertise in Medi-Cal regulatory requirements.<br><br><strong>Responsibilities</strong><br><br><strong>Your Work</strong><br><br>In this role, you will:<br><ul><li>Provide overall program leadership, guidance, and manage all aspects of the Promise Behavioral Health Committee, including the standardization of committee charters and meeting regulatory, reporting, and contractual requirements</li><li>Provide strategic direction, planning and execution of Medi-Cal behavioral health programs, for regulatory compliance and/or quality improvement, from conceptualization through implementation</li><li>Develop and optimize resource strategies to support projects and daily operations</li><li>Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders </li><li>Develop reports for leadership to understand ongoing compliance, gaps, and risks, as requested </li><li>Provide technical expertise in planning, execution, and leadership of programs, projects, and initiatives </li><li>Ensure regulatory audit preparation and performance for Medi-Cal behavioral health</li><li>Assess and resolve all high priority program risks as they are encountered</li><li>Manage the development and implementation of behavioral health projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products</li><li>Serve as a subject matter expert to regularly brief key stakeholders on different aspects of assigned initiatives</li><li>Organizes the interdepartmental activities ensuring completion of projects within the program are on schedule and maintains files of all current and historical artifacts for the behavioral health department</li></ul><br><br><strong>Qualifications</strong><br><br><strong>Your Knowledge and Experience</strong><br><br><ul><li>Requires a bachelor's degree or equivalent experience</li><li>Requires at least 7 years of prior relevant experience</li><li>Requires proficient knowledge of Medi-Cal regulations and guidelines, reporting requirements, and submission procedures</li><li>Requires administrative or clinical behavioral health experience in a health plan or medical group setting</li><li>Requires excellent communication skills, both oral and written and requires effective time management skills and ability to define and act on priorities efficiently</li><li>Requires investigative, problem solving, critical thinking and assessment skills</li><li>Requires strong organizational skills, project management experience strongly preferred</li><li>Committee governance and regulatory compliance strongly preferred</li><li>Demonstrated experience in cross-functional operational improvement activities strongly preferred</li><li>Ability to understand and interpret regulations including Senate Bills, Assembly Bills and DHCS/DMHC All Plan Letters strongly preferred</li><li>Requires advanced skills with computer programs, including Microsoft Excel, Outlook, Word, and PowerPoint, SharePoint and other collaboration platforms</li></ul><br><br><strong>About the Team</strong><br><br><b>About Blue Shield of California</b><br><br>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. <br><br>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. <br><br>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.<br><br>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! <br><br><b>Our Values: </b><br><br><ul> <li><b>Honest. </b>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.</li> <li><b>Human. </b>We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.</li> <li><b>Courageous. </b>We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.</li></ul><br> <br><b>Our Workplace Model</b> <br> <br>We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:<br> <ul> <li>For most teams, this means coming into the office two days per week.</li> <li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.</li> <li>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.</li> </ul> <br>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews. <br><br><b>Physical Requirements:</b><br><br>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.<br><br>Please click here for further physical requirement detail. <br><br><b>Equal Employment Opportunity:</b><br><br>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.