Your Role The Data Solution team is responsible for technical design and end to end delivery of complex data driven solutions and data products for the enterprise. The Solution Design Lead, Consultant will report to the Sr Manager, Data Solutions. In this role you will be partnering with Enterprise Architects, Portfolio, Analytics and Data engineering teams for designing

Our Customer Experience Teams receive incoming telephone calls from our members. Our Call Centers are open 7 days a week. If hired, you will be required to attend and complete a paid, mandatory training. Training will be held in a remote environment. Remote training requires secure, reliable internet connectivity. Any hybrid work or training requires both remote and on pr

Home Based Product Tester (No Experience Required) $25/hr $45/hr. Part Time/Full Time We are a consulting firm specializing in home based product testing for businesses worldwide. We focus on emerging ventures from Europe and Asia aiming to penetrate the US market. Our services entail delivering real time user feedback to companies and market research firms, facilitating

Your Role The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or direction to ensure that membe

Your Role The Rapid Quality Improvement team is responsible for the development and execution of targeted, quality improvement initiatives in support of the commercial medical groups, hospitals, and affiliated providers to close gaps in care for our members. The Program Manager, Consultant will report to the Senior Manager, Quality Improvement. In this role you will execu

Your Role The Provider Network Management team consists of Provider Relations and Contracting in Northern California. The Provider Contracting Specialist, Principal will report to the Director, Provider Contracting. In this role you will be responsible for managing contract negotiations for select providers in Central and Northern California. The job entails comprehensive

Your Role The Application Developer, Consultant falls under the Applications Dev Support & Continuous Integration team. The Application Developer, Consultant will report to the Manager, IT Development. In this role you will follow best software development practices in order to analyze product requirements. Remote work permitted within select states within the U.S., but m

Your Role The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or direction to ensure that membe

Your Role The Commercial Post Service Review team is responsible for clinically reviewing claims that are the result of either a preservice or claim denial. The Commercial Post Service Review RN will report to the Manager, Post Service. In this role you will perform accurate and timely clinical review of post service claims. The RNs perform reviews utilizing the Blue Shie

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination o

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi Cal Team. In this role, you will ensure that services are provided based on

Your Role The Medical Director provides clinical leadership within the Office of the CMO for Blue Shield Promise Health Plan, which includes management of the physician processes in support of utilization management and transactional functions. These functions include performance of preservice, concurrent, retrospective utilization review, Appeals and Grievances, and retr

Your Role The Customer Experience, Digital, and Operations Analytics team is responsible for accelerating data driven value based solutions that drive out expense, generate growth while elevating experience for members, providers and brokers. The Senior Manager of Digital and Marketing Analytics will report to the Senior Director of Customer Experience, Digital, and Opera

Your Role The Blue Shield of California Growth and Servicing analytics organization is part of the centralized Data and Analytics organization and oversees Channel Analytics including Digital, Marketing, Claims, Appeals, Grievances, Disputes, Customer Experience and Line of Business. This role Senior Manager Market Insights & Experience Analytics would report to the Senio

Your Role The Blue Shield of California Growth and Servicing analytics organization is part of the centralized Data and Analytics organization and oversees Channel Analytics including Digital, Marketing, Claims, Appeals, Grievances, Disputes and Line of Business. The role of Medical Informatics Analyst Consultant would report to the Manager of Medical Informatics and woul