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 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, and regulatory reporting. The Clinical Quality Analyst Consultant will report to the

Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Experienced, will report to the Mana

Your Role Our Behavioral Health Customer Experience Teams receive incoming telephone calls from BSC's fully insured group customers. Our agents are trained to go above and beyond, providing high quality, white glove, one stop shop service. The Behavioral Health Call Center is open 7 days a week, 4 45 a.m. 8 00 p.m., including most holidays. If hired, you will be required

Your Role The Provider Education team develops and delivers training and education to ensure Blue Shield's contracted providers are willing and capable of delivering a high quality member experience. The Learning Developer, Consultant is a senior Instructional Design position reporting to the Senior Program Manager, Provider Education. In this role, you will partner with

Your Role The Commercial Customer Service team assists members in navigating their health plan and ensuring access to needed healthcare services . The Operations Supervisor, Commercial Customer Experience will report to the Director of Commercial Customer Service. In this role you will Manage the daily, short term, and/or long term activities of the customer service and o

Your Role The Commercial Customer Service team assists members in navigating their health plan and ensuring access to needed healthcare services . The Program & Operations Manager, Commercial Customer Experience will report to the Director of Commercial Customer Service. In this role you will Manage the daily, short term, and/or long term activities of the customer servic

Your Role The Healthcare Quality & Affordability (HQA) Operations team leads the operational and strategic initiatives to advance affordable, high quality health care to ensure equitable outcomes, sustainable cost efficiency, and exceptional care for all. The HQA Operations Executive Assistant will report to the Vice President HQA Performance Enablement. In this role you

Your Role The Product Lifecycle team manages the end to end implementation of the Individual & Family Plan (IFP) products and renewals. The IFP Product Cycle & Renewal Manager, Senior will report to the Sr. Manager of Product Lifecycle. In this role you will be accountable for project execution of cycle related efforts to deliver the desired project outcomes. Collaboratin

Your Role The Behavioral Health Services (BHS) team is responsible for developing the foundation for and executing a best in class behavioral health insurance product for Blue Shield, including creating pricing models by line of business, and establishing a core operations infrastructure. As Director, Behavioral Health Product, reporting into the VP, Behavioral Helath Ser

Your Role The Product Platform team is looking for a Senior Platform Administrator to assist with the admin configuration and analysis as changes are needed to the platform modules that support benefit coding and product management to support the Behavorial Health benefits. The Senior Platform Administrator will report to the Senior Manager. In this role you will be worki

Your Role The Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need. The Clinical Services Coordinator (CSC) Intermediate (Appointment Assistance) will report to the Supervisor, Operations Behavioral Health. In this role you will be for supporting clinical staff day to day operations. Your Knowledge and Expe

Your Role The Utilization Management Prior Authorization team accurate and timely prior authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The Utilization Management Nurse, Senior will report to the Manager, Utilization and Medical Review. In this role you will be performing first level determination app

This position is based out of California. Your Role The Blue Shield of California Commercial Finance team is responsible for providing financial planning and analysis support for the mid to large segment employer groups. The Financial Analyst, Experienced will report to the Financial Analyst, Principal. In this role, you will be responsible for the monthly close deliverab

Projected Start date October, 6 th 2025 Mandatory Training Remote As a Concierge Customer Service Representative (CSR), you are in charge of upholding our mission of providing a service worthy of our family and friends. Our members look to you to help them navigate healthcare, providing empathy and advocacy. You are empowered to provide members with peace of mind that the