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

Your Role The Medical Care Solutions Clinical Service Intake team responsible for timely and accurate processing of Treatment Authorization Request. The Clinical Services Coordinator will report to the Supervisor of Clinical Services Intake. In this role you will be for supporting clinical staff day to day operations for Promise lines of business. Your Work In this role,

Your Role The ACA Chart Program team conducts the following functions (1) identify medical records with unreported diagnosis codes, (2) retrieve those medical charts, (3) perform medical coding to convert them into risk adjustable diagnosis codes, and (4) submit to CMS via the EDGE pathway . The Risk Adjustment, Consultant will report to the Senior Manager . In this role

Your Role The Transformation team is responsible for improving the lives of those we serve by making the extremely complex, absurdly simple. The Product Manager, Principal will report to the Senior Manager of End to End Provider Experience Transformation. In this role you will be responsible leading our critical strategies to drive improved quality of interactions, overal

Your Role The Corporate Services Finance team ensures financial stewardship of the Corporate Services administrative budget and serves as the trusted financial advisor to executive leadership. Our team is looking for a Financial Analyst, Consultant to steer financial performance toward Blue Shield goals. The position will support annual planning, monthly forecasting, mont

Your Role The Federal Employee Program team is responsible for Federal Employee Health Benefits and serves all federal employee is the state of California. The Account Manager Federal Employee Program, Senior Central Valley will report to the Senior Manager, Account Management, FEP. In this role you will be primarily responsible for the sales, retention, and support of go

Your Role The People & Engagement HR Connect team is a critical part of Human Resources service delivery for all of Blue Shield of California (BSC) The team provides first level support to all BSC employees on a daily basis for both daily operations and employee facing initiatives. The HR Specialist, Advanced will report to the Manager, HR Connect. In this role you will b

Your Role The Social Services Representative, Advanced will report to the Supervisor, Social Services. In this role you will provide telephonic social services support and resource referrals for high acuity Blue Shield Promise members, in addition to administrative support to the Social Services Management Team. The Social Services Representative regularly reaches out to

Your Role The Provider Education team develops learning resources for contracted providers to help them work more effectively with Blue Shield and promote member satisfaction. The Learning Systems Administrator, Experienced will report to the Sr. Program Manager, Provider Education. In this role, you will manage and execute implementation and delivery of internal and exte

Your Role The Medical Care Solutions team manages the clinical operations including utilization management, care management and clinical programs. The Product Manager will initially report to the Vice President of Medical Care Solutions. In this role you will be responsible for setting product vision and strategy via understanding of customer needs and organizational prio

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the f

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the f

Your Role The Medical Director, Commercial is a key member of the Medical Management and Operations staff within Health Care Services. This is a front line utilization management position that has core responsibilities in the areas of pre and post service utilization review, and collaboration with RN Case and disease managers.This director position will report to the Medi

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 Compensation team is an in house center of expertise and consulting team and provides leadership and guidance in the development and delivery of effective compensation strategies and policies that support BSC's goals, and are in alignment with enterprise values, philosophy and strategic direction.. The Senior Compensation Analyst will report to the Senior Ma