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 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 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 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 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

Your Role The Technology Business Management team is focused on optimizing spend for IT services by driving Technology Business Management and FinOps practices and aligning IT costs to services for total cost of ownership. The team provides IT financial data and analysis that empowers leaders to make informed business decisions as Blue Shield of California leverages cloud

Your Role The Premier Underwriting team manages the pricing of medical, dental, vision, and life products for employer groups over 3,000 subscribers and all size Labor and Trust groups. The Premier UW Consultant will report to the Senior Manager of Premier, Northern California. In this role you will be assigned and responsible for a renewal book of at least $100M in annua

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 Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and

Your Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and care management

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