Job Description:

Reporting to the Senior Director of Operational Excellence, the role of the Director, Operations - Controls & Quality Assurance - Medicare, Medi-Cal, & IFP is critical to the success of Blue Shield of California and the Operational Excellence department in realizing its goals and objectives. This individual will play a key role as part of the Operational Excellence team in delivering and collaborating on all aspects of controls, quality, and audit readiness for the Consumer segment, which includes Medi-Cal, Medicare, and Individual & Family Plan. The Director role will also drive operational readiness, audit and mandate compliance, lean sigma process, quality control, vendor management, budgeting, reporting, and key performance indicators.

Specifically the Director, Operations - Controls & Quality Assurance - Medicare, Medi-Cal, & IFP role will be accountable for:

- Developing near and long term business strategies for the Consumer controls, quality assurance, and audit readiness programs

- Demonstrating and exemplifying BSC Leadership Behaviors and drives the behaviors throughout the controls and quality assurance teams

- Fostering a great place to do meaningful work by clearly defining 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.

- Providing executive oversight and leadership to Managers responsible for creating and driving implementation of plans, which are required to support immediate and long-term business strategies.

- Leading and influencing relationship management with cross-functional leaders across the enterprise, and manages cross-functional operational linkages to ensure end to end business processes surrounding operational areas meet customer and stakeholder requirements.

- Developing appropriate relationships and drives coordination process to ensure business and operational linkage with business unit goals and objectives, ensuring satisfactory capacity and quality/production support will be available to meet these goals.

- Acting as Change Leader and assertively managing cross-functional relationships to ensure sustainability of end-to-end process quality and compliance

- Defining and establishing key performance indicators and controls which are reflective of and measure Blue Shield of California's competitive position relative to quality and compliance delivery with ongoing measurement, reporting, and root cause analysis

- Ensuring that performance objectives and outcomes are consistent with external and internal customer expectations and meet competitive benchmarks; routinely integrates customer feedback and competitive information into ongoing planning and activities.

- Defining and implementing appropriate organizational structure to facilitate effective delivery of controls, quality, and audit readiness programs within Consumer lines of business

- Ensure optimization of resources by resolving any duplicative improvement efforts, roles, and organization structures

- Ensuring effective stakeholder management across the enterprise and holding functional leaders accountable to designing, implementing, and monitoring effective quality and compliance controls.

- Ensuring traceability of all regulatory and operational compliance is designed into operational end-to-end processes and monitored for self-assessment, self-reporting, and audit readiness

Education/Credentials

* Minimum of 10 years of related experience; including 6
years of leadership experience or equivalent combination of education and
experience

* Bachelor's degree
required; Master's degree preferred

Candidate Profile and Requirements

*
Experience driving Cross-functional Team Leadership, Quality Control programs,
Business Strategy Development, Business Process Design, Project Management.

*
Experience managing operations, compliance and audit readiness activities in
one more of Medi-Cal, Medicare, and Individual & Family Plans.

Key Job Competencies

*
Strategic planning and business planning, quality systems, driving technical
change, analytical skills, leading through change.

*
Quality Control systems

*
Driving technical change

*
Analytical skills

*
Leading through change

Additional Information

- Our Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!

- 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.

- 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.

- Requisition ID: 20001TE

- Posting Date: Sep 24, 2020

- Schedule: Full-time

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