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 Behavioral Health Registered Nurse Case Manager will report to th

Your Role The Community Programs team provides high touch engagement with member and community based organizations to remove barriers to health care access, enhance population health initiatives and advance health equity. The Community Health Advocate Coordinated Entry System (CES) Liaison will report to the Community Programs Manager, Operations. In this role you will be

Your Role With pharmacy benefits being an essential component of the medical benefits, Pharmacy Care Reimagined is a critical Blue Shield of California initiative along with other Health Care Reimagined initiatives. The Pharmacy Care Reimagined goal is to enable every person with safe, equitable access to sustainably affordable prescription drugs. To enable our vision, we

Your Role The Director of Facilities will report to the VP Internal Audit Services. In this role you will manage the real estate, security, and facility operations for Blue Shield of California for multiple locations of over 1.2M and 7,500 employees. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow pers

Your Role The Community Programs team provides high touch engagement with member and community based organizations to remove barriers to health care access, enhance population health initiatives and advance health equity. The Community Health Advocate Coordinated Entry System (CES) Liaison will report to the Community Programs Manager, Operations. In this role you will be

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 Survey Analytics would report to the Senior Director of Growth a

Your Role The Compensation team is an in house center of expertise and consulting team and provides leadership and guidance in the development and delivery of effective compensation strategies and policies that support BSC's goals, and are in alignment with enterprise values, philosophy and strategic direction.. The Senior Compensation Analyst will report to the Senior Ma

Your Role The Healthcare Business Operations (HBO) team provides centers of excellence for healthcare business resolution practice. Our team is responsible for transforming how we operate throughout the enterprise and has a significant impact on our spend. The Senior Manager, Operations role will report to the Director of Provider Dispute Resolution in Healthcare Business

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 Care Management Clinical Social Work team helps Blue Shield members with complex social determinants of health by conducting psychosocial assessments, developing care plans, and providing intensive interventions. The Care Management Social Worker will report to the Manager and/or Senior Manager of Care Management Clinical Social Work. In this role you will b

Your Role The Data and Analytics (D&A) organization focuses enterprise wide to partner with business stakeholders to apply the power of data & analytics to deliver new insights and data driven solutions to accelerate business outcomes. The Data Services & Solutions team is part of the centralized D&A organization and oversees the design and implementation of data solution

Your Role The Actuarial Provider Strategies team helps design and implement value based care (VBC) payment models, which include Accountable Care Organizations (ACOs) and other innovative alternative payment models (APMs) to improve the affordability and quality of care our members receive. The Experienced Actuarial Analyst will report to the Senior manager of Actuarial P

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 Medical Director, Commercial 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 pre and post service utilization review, and collaboration with RN Case and disease managers.This director position will report to the Medi

Your Role The Business Configuration team designs, builds, delivers, and maintains configuration, optimizing functionality to support Blue Shield's business objectives. The Configuration Analyst will report to the Manager of IT Development. In this role, you will be responsible for configuration unit testing. Your Work In this role, you will Analyze medium to hard custome