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 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 Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi Cal Team. In this role, you will ensure that services are provided based on

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

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

Your Role The Trust Assurance Services team drive BSC information security adherence to regulatory standards, as well as policies, standards, and controls with the goal of safeguarding company assets and maintaining confidentiality, integrity, and availability of information. The Technical Business Continuity, Principal will report to the Senior Manager, Technical Busines

Your Role The Corporate Communications team supports Blue Shield of California's reputation with both internal and external audiences through employee engagement, media and executive visibility. The Senior Communications Manager will report to the Senior Director of Corporate Communications. In this role you will lead a team supporting the Chief Human Resources Officer an

Your Role The Communication Governance team supports the development and implementation of strategic communication programs to improve overall member experience, streamline operational processes, and govern member facing communications to align with company policies and regulatory requirements. The Marketing Operations Specialist, Consultant Communication Governance will

Your Role The Program Manager Clinical, Principal in collaboration with the Regional Medical Director and internal Blue Shield of California teams will be responsible for collaborating with all externally facing partners to transform the way health care is delivered, ensuring best in class care for all members. Priority is given to delivering on the Quadruple Aim (lower c

Your Role The IT Development Center Of Excellence team at Blue Shield is tasked with establishing best practices and standards as we rapidly transform ourselves to be a digital first company. The DevSecOps Engineer, Principal will report to the Sr Manager, IT Development Centers Of Excellence. As a DevSecOps Engineer, you will play a critical role in assessing our current

Your Role The Operations Portfolio team within Blue Shield of California provides robust solutions for our business partners, providers and members which improve the overall health care experience from claims processing to benefit enrollment. IT Product Manager, Consultant will report to the Senior Manager, Applications Services Lead in the Operations Portfolio. In this r

Your Role The Utilization Management team facilitates the review of requests for medical necessity to assure that care is provided to our members timely, at the correct level of care with quality and cost effectiveness standards. The Utilization Management Nurse Consultant will report to the Utilization Management Manager. In this role you will be an individual with advan

Your Role The Sr. Director, Legal Counsel will be a member of Blue Shield's Law Department and will be a leader in the company. The Law Department partners with the company's business leaders to embrace legal and ethical behavior in the achievement of the company's mission. This team is highly regarded within the company and respected by management. It is comprised of top