Your Role The Delegation Oversight Utilization Management team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting that track and compare patters of delegated entities. The Delegation Operations Nurse Auditor LVN Experience

Your Role The Innovation Analyst, Consultant is responsible for supporting the improvement and maintenance of our integrated enterprise strategy to execution process and supporting initiatives designed to provide strategic thought leadership to business leaders across the enterprise to address ambiguous problems and opportunities. This role will serve as a change agent, l

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

Your Role The Reporting, Analysis and Administration team supports Blue Shield of California with design, development, and management of Verint, Genesys and Avaya platforms. We provide business support expertise and manage requirements deliverables. Currently, this includes Routing, Quality, Speech, WFM, Performance Management and Desktop Analytics modules. The Business A

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 Appeals and Grievances Pharmacy team researches and resolves member/subscriber grievances, appeals and complaints, and interprets and explains health plan benefits, policies, and procedures to appellant. The AGD Intermediate coordinators will report to the team's Operational Supervisor. In this role you will clarify issues, educate members in the process and

The Commercial Member Acquisition marketing team is looking for a dynamic marketing professional to join us as the Marketing Campaign Specialist, Senior Member Acquisition. The team are passionate marketers at heart driven to create the most compelling member experience so that Blue Shield is the health plan carrier of choice during open enrollment. The Marketing Campaign

Your Role The Blue Shield of California Finance team is responsible for providing Line of Business consolidation, reporting, and analysis support for the Growth Finance team. The Financial Analyst, Consultant will report to the Markets Planning and Analysis Finance Manager. In this role, you will work closely and collaborate with other stakeholders (actuarial, accounting,

Summer 2024 Information & Technology General Internship About Our Internships Our paid internship program is thoughtfully curated to provide students experience and exposure to the health professional industry. Interns will be given the opportunity to get hands on experience with real work projects, build meaningful relationship and connections within the organization, an

Your Role The Core Account Service Team is responsible for the retention of existing membership and the pursuit of new business within the medium to large business segment. The Senior Account Service Representative will report to the Senior Service Manager. In this role you will be responsible for the day to day relationships within your book of business. You will also be

Your Role The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or direction to ensure that membe

Your Role The Clinical Service Coordinator, Specialist responsible for the daily operations within the Promise Health Plan Case Management Department for non clinical functions. The Lead will be responsible for the coordination of Health Risk Assessment / Individualize Care Plan Outreach Process, Case Management services, Transitions of care services provided by the PHP C

Your Role The Actuarial Reserving team develops Incurred but Not Reported (IBNR) reserve models and reporting while considering the impacts of emerging operational and trend dynamics on reserve levels . The Actuarial Analyst, Experienced will report to the Senior Manager of Reserving. In this role you will collaborate with partners in Accounting, Operations, IT, and other

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 Case Management, Senior will report to the CHP Manager. In this role you will be Perform clinical review, assessment, evaluation of medical services for the organization us

Your Role The Network Trend Analytics team is responsible for performing financial modeling and analytics for provider contract negotiations for hospitals and ambulatory surgery centers. The Associate Actuarial Analyst will report to the Senior Manager. In this role you will be applying your analytical toolset to project future unit cost trends and drive the development o