Blue Shield of California
39 jobs found
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Utilization Management Nurse, Senior
Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facilit
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Senior Medical Director, Behavioral Health
Your Role The Medical Management team ensures that Blue Shield of California is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Senior Medical Director, Behavioral Health will report to the Vice Pr
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Social Services Representative, Advanced
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 Service
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Actuarial Analyst, Senior
Your Role The Blue Shield’s Risk Adjustment (RA) Chart Review and Analytics team plays a crucial role in bringing healthcare into the digital age. The RA team is highly cross-functional, with each team member deeply skilled in both business-operations and data-analytics; this enables us
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Case Management - Nurse, Senior
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
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Director, Commercial Utilization Management
Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key r
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Clinical Quality Analytics, Senior
Your Role The Clinical Quality Analytics and Informatics team delivers best-in-class clinical quality analytics and informatics to enable high quality and affordable member-centered care. Our data, intelligence, and actionable insights help drive quality strategy, performance improvement, an
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Case Management - Behavioral Health Nurse
Schedule is Mon-Fri 10am-7pm The Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. The Federal Employee Program (
