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 Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities in collaboration with members and those involved with members' care including registered nurse case managers, social workers, dietitians, health coaches, pharmacists, and physicians. The FEP Health Coach will report to the FEP Department Manage

Your Role The Data Solution team is responsible for technical design and end to end delivery of complex data driven solutions and data products for the enterprise. The Solution Design Lead, Consultant will report to the Sr Manager, Data Solutions. In this role you will be partnering with Enterprise Architects, Portfolio, Analytics and Data engineering teams for designing

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 This position is located in our Panorama City Community Resource Center Location & require employee to work 5 days per week in the Panorama City Community Resource Center The Community Programs team provides high touch engagement with members and community based organizations to remove barriers to healthcare access, enhance population health initiatives and adva

Your Role The Blue Shield of California Promise Health Plan Clinical Access Programs department is responsible for regulatory oversight and audits of providers to ensure the quality of care and services received by our members, monitoring and oversight of access and availability of care, and member outreach and coordination of care. The Business Analyst, Consultant will r

Your Role The Installation and Billing (I&B) team within Blue Shield of California oversees the enrollment, billing and payments process for their groups and members. The Experienced Business Analyst will report to the Manager of Programs and Projects. In this role you will drive the facilitation, management and analysis of incidents related to enrollment, billing, and in

Your Role The Global Business Services (GBS) department is responsible for delivering strategic and category supplier sourcing, contracting and governance excellence at Blue Shield of California. The Senior Manager, Procurement Contracting role will report to the Director, Contracting. In this role you will be responsible for the management, prioritization and execution o

Your Role The Information Security team is responsible for governance over the exchange of protected health information (PHI) and sensitive data with external entities. The Information Security Data Exchange Expert, Principal will report to the Senior Manager, Information Security Data Exchange. In this role you will be responsible for the privacy and security frameworks

Your Role The B2B Customer Experience team is responsible for supporting Blue Shield of California Providers through their servicing needs building strong relationships and ensuring ongoing loyalty to the Blue Shield brand. The Sr. Manager, Service Strategy and Operations of B2B Services will report to the Senior Director of Broker, Employer & Provider Services. In this r

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 im

Our Customer Experience Teams receive incoming telephone calls from our members. Our Call Centers are open 7 days a week. If hired, you will be required to attend and complete a paid, mandatory training. Training will be held in a remote environment. Remote training requires secure, reliable internet connectivity. Any hybrid work or training requires both remote and on pr

Your Role The Law Business team brings experience, expertise and solutions in technology, data management and other support services to help the Law Department continuously improve and excel in our support of BSC and its affiliates. The Business Analyst will be responsible for providing technical support to the Law Department teams and will report to the Law Business Team

Your Role The Medi Cal Program Support (MPS) team ensures sufficient and complete Medi Cal operational documentation by reviewing and supporting development of business process documentation; development of regulatory data and files process documentation; and development of employee trainings. The Business Analyst will report to the Senior Manager of the Business Process

Your Role The Special Investigations Unit team is responsible for preventing, detecting, investigating, and resolving health care fraud, waste, and abuse . The Special Investigations Investigator, Consultant will report to the SIU Manager. In this role you will represent a high level of professionalism both internally and externally. Conduct investigations in accordance w