Operations Specialist, Principal

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. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

Description:

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 Quality Governance team ensures Blue Shield's ongoing compliance with regulatory requirements for the Clinical Quality Department, through oversight quality committees, collection of documentation that shows monitoring and tracking of key metrics and their related functions and ensuring that new requirements are rolled out and tracked. The Principal Operations Specialist will report to the Quality Governance Senior Manager, Program and Project Management. In this role you will be the subject matter expert on quality related operational workflows, databases, systems and applications, procedures, tools and documentation. You will work to enhance the department's operating efficiency, attention to detail/quality, and technical skill levels of staff. You will create/present executive level reports and conduct root cause analyses, as well as make recommendations for addressing identified issues.

Your Work

In this role, you will:

• Act as a lead subject matter expert to review operational workflows of high complexity for multiple departments, identifying problems and developing improvements, modifications, and enhancements
• Create tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff
• Provide leadership in tracking and communicating workflow and system changes to appropriate sources
• Develop and generate reports for management review
• Participate as a Subject Matter Expert (SME) in the development of written guidelines
• Monitors and reports operational timeliness of Potential Quality Issues (PQIs) and other quality related regulatory turnaround times (for in-house and/or external specifications and standards)
• Reviews cross departmental systems and applications and recommends edits/changes to ensure streamlined processes
• Revises policies and procedures to ensure compliance with new / updated regulatory changes
• Develops and leads training opportunities for staff related to above requirements
• Responsible for timely escalation of issues and subsequent coordination of Corrective Action Plans (CAPs)

Qualifications:

Your Knowledge and Experience

Requires a bachelor's degree or equivalent experience

Requires at least 10 years of prior relevant experience

Excellent presentation/design, speaking, analytic and problem-solving skills

Requires deep knowledge of quality related activities for healthcare environment - typically obtained through advanced education combined with experience

Must have broad knowledge/experience in project management and be comfortable managing large multi-departmental projects with limited oversight

Must be a team player, must build relationships with business partners internal and external to department, and be persuasive/influencing in order to achieve aims

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