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Blue Shield of CA
- Long Beach, CA / Oakland, CA / El Dorado Hills, CA / 3 more...
Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Senior will report to the Director, Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products. You will be responsible for comprehensive m
Posted 18 days ago
Blue Shield of CA
- El Dorado Hills, CA / Oakland, CA / Long Beach, CA / 3 more...
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 Registered Nurse Case Manager will report to the FEP Department M
Posted 18 days ago
Blue Shield of CA
- Woodland Hills, CA / Oakland, CA / Long Beach, CA / 3 more...
Your Role The Care Management Department, which oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must posses
Posted 19 days ago
Blue Shield of CA
- Oakland, CA / Long Beach, CA / El Dorado Hills, CA / 3 more...
Your Role The Internal Auditor Consultant will report to the Internal Audit Senior Director. In this role you will be responsible for providing objective examinations of evidence for providing independent assessment to the Audit Committee, management and outside parties on the adequacy and effectiveness of governance, risk, management and control processes. Your Work In t
Posted 20 days ago
Blue Shield of CA
- El Dorado Hills, CA / Oakland, CA / Long Beach, CA / 2 more...
Your Role The Installation and Billing (I&B) team within Blue Shield of California oversees the enrollment and billing and payments process for their groups and members. This role, Product Owner Consultant, will report to the Manager of Programs and Projects and will be responsible for the development and enhancement of our Medi Cal enrollment process, as well as oversee
Posted 20 days ago
Blue Shield of CA
- Long Beach, CA / Oakland, CA / El Dorado Hills, CA / 3 more...
Your Role Clinical Quality Analytics team is looking for a Clinical Quality Analytics, Senior who has hands on experience on data analysis, research and programming using SAS from various data sources (flat files, relational databases, other SAS datasets etc.) using Base SAS. TheClinical Quality Analytics, Senior will report to the Manager, Clinical Quality Analytics. In
Posted 20 days ago
Blue Shield of CA
- Rancho Cordova, CA / Oakland, CA / Long Beach, CA / 2 more...
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
Posted 24 days ago
Blue Shield of CA
- Long Beach, CA / Oakland, CA / Los Angeles, CA / 3 more...
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
Posted 24 days ago
Blue Shield of CA
- El Dorado Hills, CA / Oakland, CA / Long Beach, CA / 3 more...
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
Posted 24 days ago
Blue Shield of CA
- Rancho Cordova, CA / Oakland, CA / Long Beach, CA / 3 more...
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
Posted 28 days ago
Blue Shield of CA
- El Dorado Hills, CA / Oakland, CA / Long Beach, CA / 3 more...
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
Posted 1 month ago
Blue Shield of CA
- Rancho Cordova, CA / Oakland, CA / Long Beach, CA / 3 more...
Your Role The Case Management team performs and case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs.. The Case Management Nurse, Senior will report to the Manager, Care Management. In this role you will determine, develop and imp
Posted 1 month ago
Blue Shield of CA
- Long Beach, CA / Oakland, CA / El Dorado Hills, CA / 3 more...
Your Role The Communication Governance team supports the development and implementation of strategic communication programs to improve overall member experience, streamline operational processes, and govern member facing communications to align with company policies and regulatory requirements. The Marketing Operations Specialist, Consultant Communication Governance will
Posted 1 month ago
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