Your Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with their care including a multidisciplinary team and the member's treating physicians . The Registered Nurse Case Manageme

Your Role The QC Pricing Analytics and Contract Configuration team is responsible for performing an in line audit for all negotiated provider contacts. The QC Configuration Analyst, Experienced will report to the QC Pricing Analytics Contract Configuration Manager. In this role, you will conduct audits and run test claims to ensure future claims will be paid correctly bas

Your Role The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and

Your Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and care management

Your Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and care management

Your Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and care management

Your Role The Career and Leadership Development team provides opportunities for career growth at all levels of the organization through building a culture of learning, galvanizing career ownership and offering leadership development programs that prepare leaders to excel and advance in their careers. As an Organization Development and Learning Specialist, Principal, you w

Your Role The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment

Your Role Join Blue Shield's dynamic Enterprise Learning organization, which develops learning solutions to ensure employees can perform their jobs effectively to further our mission. As a IT Learning Developer, Senior you will serve as a strategic partner to talent mobility through innovative learning strategies and solutions. The IT Learning Developer, Senior will repor

Your Role The enterprise wide Data & Analytics (D&A) team is seeking to hire a Strategic Planning & Chief of Staff, Principal. This role reports directly to VP of Data & Analytics and is expected to work team wide, IT wide, and enterprise wide as a critical part of Blue Shield's data driven and mission driven journey of transforming the world of healthcare. The D&A team p

Your Role The Reporting, Analysis and Administration team supports Blue Shield of California with design, development, and management of Verint, Genesys and Avaya platforms. We provide business support expertise and manage requirements deliverables. Currently, this includes Routing, Quality, Speech, WFM, Performance Management and Desktop Analytics modules. The Business A

Your Role The Information Security team is responsible for providing cyber security services to Blue Shield of California that enable secure product development and operations. The Principal Program Manager, Information Security will report to the Sr. Director . In this role you will play a pivotal role in orchestrating the development and execution of our comprehensive s

Your Role The Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post service or claim denial. The Appeals and Grievances RN Senior will report to the Manager of the Appeals and Grievances team. In this role you will perform accurate and timely clinical review of member initiated ap

Your Role The Cost of Healthcare Trendsetters & Pharmacy Support team analyzes and provides emerging healthcare cost trend drivers. The Medical Informatics Analyst IV will report to the Actuarial Manager. Your Work In this role, you will Conduct independent analysis of high complexity under minimal supervision and guidance Develop analytical methods so that they may be su

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Behavioral Health Registered Nurse Case Manager will report to th