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 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 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 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 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

Your Work In this role, you will Be responsible for analytic work required to convert pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Build and update models that allow the actuarial team to quantify financial gaps and opportunities at a provider level Conduct and devel

Your Work In this role, you will Be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Create value for the Growth team General Managers by ensuring they have a voice when it comes to key network decisions and network strategy Create value for th

Your Role The Network Management and Provider Partnerships team is responsible for supporting Enterprise led mandates and managing all Business led mandates. The Program Manager, Principal will oversee the intake, review, and impact assessment for all mandates to determine what Network Management teams may be impacted. This role will ensure appropriate representation from

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 Medical Care Solutions Clinical Service Intake team responsible for timely and accurate processing of Treatment Authorization Request. The Clinical Services Coordinator will report to the Supervisor of Clinical Services Intake. In this role you will be for supporting clinical staff day to day operations for Promise lines of business. Your Work In this role,

Your Role The ACA Chart Program team conducts the following functions (1) identify medical records with unreported diagnosis codes, (2) retrieve those medical charts, (3) perform medical coding to convert them into risk adjustable diagnosis codes, and (4) submit to CMS via the EDGE pathway . The Risk Adjustment, Consultant will report to the Senior Manager . In this role

Your Role The Corporate Services Finance team ensures financial stewardship of the Corporate Services administrative budget and serves as the trusted financial advisor to executive leadership. Our team is looking for a Financial Analyst, Consultant to steer financial performance toward Blue Shield goals. The position will support annual planning, monthly forecasting, mont