Your Role The Federal Employee Program team completes benefit and medical necessity reviews for members enrolled in the FEP PPO benefit plans. The Board Certified Behavioral Analyst (BCBA) will report to the Utilization Review Clinical Manager. In this role you will be responsible for prior authorization, case management and post service medical necessity reviews for the

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 Senior will report to the Cli

Your Role The Medicare Appeals and Grievances team is responsible for compliance processing of Medicare appeals and grievances. The supervisor will report to the Sr. Manager for Medicare Appeals and Grievances. In this role you will manage the daily, short term, and/or long term activities of the customer service and operations teams to ensure alignment with service level

Your Role The IT Business Operations team plays a critical role in enhancing business and IT collaboration through a Portfolio based model. The System Analyst, Consultant will report to the Senior Manager, IT Product Management. In this role you will analyze data at a team and portfolio level, in a manner to tell stories to leadership. Your Work In this role, you will For

Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Senior will report to the Director, Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products. You will be responsible for comprehensive m

Your Role The Quality Governance team is responsible for managing key and critical health plan quality program functions and processes. The Principal Program Manager will report to the Senior Manager, Quality Governance. In this role you will be is responsible for the leading and overseeing the coordination and implementation of quality related regulatory activities, and

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 Registered Nurse Case Manager will report to the FEP Department M

Your Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Operations for the Transitional Care Services Team which manages our Medi Cal member population. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficientl

Your Role The Advanced Analytics team for delivering Predictive and Perscription Analytics, GenAI applications, and Advanced Statistical models to our business users. The Cloud Engineer will report to the Director of Advanced Analytics. In this role you will Design, build and maintain continuous integration/continuous delivery (CI/CD) pipelines with embedded testing to ef

Your Role As a DevSecOps Engineer in IT Quality Engineering Organization, you will play a crucial role in ensuring the security and quality of software products. As part of a Center of Excellence, your primary responsibility will be to establish best practices and standards for DevSecOps methodologies, ensuring a secure and seamless transition to the cloud environment. Yo

Your Role The Care Management Department, which oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must posses

Your Role TheDigital Member Experienceteamis driving better access to healthcare for our members by reimagining our digital customer experience. The Principal Product Manager will report to the Sr. Manager, Product Management Digital Member Experience. In this role you willleverage your expertise in product management and consumer experiences to help drive member satisfac

Your Role The Digital Member Experience team is reimagining our digital customer experience and leading the transformation of the healthcare industry. The Product Manager, Consultant will report to the Sr. Manager, Product Management Digital Member Experience. In this role you will leverage your expertise in Product Management and consumer experiences to help us define th

Your Role The Customer Experience Insights team is responsible for all Operational Key Performance Indicator Reporting and Analysis for the Customer Experience Call Center teams. The Business Analyst, Senior will report to the Senior Manager, Insights Team. In this role you will support the Customer Experience (Member/Broker/Provider) Insights team with their performance

Your Role This position is located in our Lincoln Heights Community Resource Center Location & require employee to work 5 days per week in the Lincoln Heights Community Resource Center The Community Resource Center (CRC) team is responsible for managing the Blue Shield Promise Health Plan Information Resource Center (IRC) and jointly operating CRCs throughout Los Angeles