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

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 Medical Director, Operations Federal Employee Program, 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 inpatient concurrent review, pre and post service utilization review, and collaboration with RN Case and disease

Your Role The Strategic Partnerships and Pilot Programs unit seeks a Market Researcher, Principal to join the Design Studio, a user experience focused team central to piloting innovative member centered solutions to improve health outcomes for Blue Shield of California members and their communities. The researcher in this role will report to the Senior Manager of Market R

Your Role The Business Architecture team, within the Enterprise Architecture organization, is responsible for developing strategies and multi year integrated roadmaps that bridge our business portfolios and technology vision. The Enterprise Business Architect, Principal will report to the Sr. Director, Business Architecture and Innovation Product Strategy. In this role yo

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 Core Account Service Team is responsible for the retention of existing membership and the pursuit of new business within the medium to large business segment. The Senior Account Service Representative will report to the Senior Service Manager. In this role you will be responsible for the day to day relationships within your book of business. You will also be

Your Role The Care Management team is looking for a leader with Care Management experience who can help design and lead our Population Health management (PHM) Medi Cal Care Management line of business. The Manager, Care Management will report to the Senior Manager of Care Management PHM. In this role you will act as the practice and operational leader for the care manager

Your Role The Actuarial Pricing Shared Services team is responsible for collaborating with different Finance and Actuarial teams to support enterprise financial tracking and forecasting and drive the pricing target setting and planning to meet Company's operating and growth goals. The Senior Actuarial Analyst will report to the Senior Manager of the Actuarial Pricing Shar