Your Role The Internal Auditor Consultant will report to the Internal Audit Senior Director. In this role you will be responsible for providing objective examinations of evidence for providing independent assessment to the Audit Committee, management and outside parties on the adequacy and effectiveness of governance, risk, management and control processes. Your Work In t

Your Role The Installation and Billing (I&B) team within Blue Shield of California oversees the enrollment and billing and payments process for their groups and members. This role, Product Owner Consultant, will report to the Manager of Programs and Projects and will be responsible for the development and enhancement of our Medi Cal enrollment process, as well as oversee

Your Role Clinical Quality Analytics team is looking for a Clinical Quality Analytics, Senior who has hands on experience on data analysis, research and programming using SAS from various data sources (flat files, relational databases, other SAS datasets etc.) using Base SAS. TheClinical Quality Analytics, Senior will report to the Manager, Clinical Quality Analytics. In

Your Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with their care including a multidisciplinary team and the member's treating physicians . The Registered Nurse Case Manageme

Your Role The Strategic Planning and Performance team responsible for issue and risk management for operational contact center teams (both tactical and proactive), and for Business Continuity planning and management. The Program Manager, Principal for Risk Management and Business Continuity will report to the Strategic Planning and Performance Director. In this role you w

Your Role The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment

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 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 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 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 Case Management team performs and case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs.. The Case Management Nurse, Senior will report to the Manager, Care Management. In this role you will determine, develop and imp