Your Role The Blue Shield of California Finance team is responsible for providing Line of Business consolidation, reporting, and analysis support for the Growth Finance team. The Financial Analyst, Consultant will report to the Markets Planning and Analysis Finance Manager. In this role, you will work closely and collaborate with other stakeholders (actuarial, accounting,

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 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 Quality Improvement Team is accountable for quality ratings of the organization and the development and execution of targeted, quality improvement initiatives in support of the commercial medical groups, hospitals, affiliated providers, and our Covered California membership. The Program Manager, Senior will report to the Manager, Program and Project Manageme

Your Role The Platform Strategy and Operations Team is focused on optimizing Salesforce solutions and maximizing value across the enterprise. Salesforce is an enterprise platform targeted to help accelerate our transformation program, enable innovation, and help realize our vision for a reimagined healthcare system. Our team works cross functionally to link our key busine

Your Role The Data Solution team is responsible for technical design and end to end delivery of complex data driven solutions and data products for the enterprise. The Solution Design Lead, Consultant will report to the Sr Manager, Data Solutions. In this role you will be partnering with Enterprise Architects, Portfolio, Analytics and Data engineering teams for designing

Our Customer Experience Teams receive incoming telephone calls from our members. Our Call Centers are open 7 days a week. If hired, you will be required to attend and complete a paid, mandatory training. Training will be held in a remote environment. Remote training requires secure, reliable internet connectivity. Any hybrid work or training requires both remote and on pr

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 Provider Network Management team consists of Provider Relations and Contracting in Northern California. The Provider Contracting Specialist, Principal will report to the Director, Provider Contracting. In this role you will be responsible for managing contract negotiations for select providers in Central and Northern California. The job entails comprehensive

Your Role The Application Developer, Consultant falls under the Applications Dev Support & Continuous Integration team. The Application Developer, Consultant will report to the Manager, IT Development. In this role you will follow best software development practices in order to analyze product requirements. Remote work permitted within select states within the U.S., but m

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 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