Sr. Manager, Clinical Quality Review

Your Role

The Clinical Quality Review team reviews potential quality issues that are received by our members, providers, or are internally identified by staff. In collaboration with our medical directors, the team follows up / reports results to the appropriate committees for further resolution. The Sr. Manager, Clinical Quality Review, will report to the Director, Clinical Quality - Quality Management & Assurance. In this role, you will be overseeing a team of Registered Nurses (RNs) and administrative staff to ensure operational compliance with timeliness and reporting requirements. You will also complete reports to various committees on team statistics.

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 Knowledge and Experience

• Requires a Bachelor's degree in Nursing, Public Health, or other related field. Master's degree is preferred
• Requires at least 10 years of prior relevant experience including 4 years of management experience
• Clinical Registered Nurse (RN) California license required
• Demonstrated experience in cross-functional operational leadership and in coaching, mentoring and guiding employees in areas related to change management and operational process improvement
• Demonstrated investigative, problem solving, critical thinking and assessment skills; working knowledge of industry related systems (including basic applications, EMRs and systems such as EPIC, CERNER, MediTech)
• Health care / Managed care experience (i.e. broad knowledge of current concepts, practices and procedures within the health care field, especially related to HMO, Medicare and Medi-Cal)
• Excellent communication skills, both written and oral

Pay Range:

The pay range for this role is: $120,120.00 to $180,180.00 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.

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