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 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 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

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 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

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 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