Your Role The Duals Outreach & Enrollment Manager is responsible for planning and executing beneficiary education, enrollment, community events, meetings, and conducting provider education and outreach for the purpose of growth and retention. The Duals Outreach & Enrollment Manager will report to the Senior Manager, Duals Outreach and Enrollment. In this role you will be

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the f

Your Role The Senior Director, Associate General 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 c

Your Role The Medicare team is responsible for servicing Medicare members including Med Supp an). Total Duals / D SNP (Dual Special Need Plans. The Supervisor will report to the department Manager. In this role you will manage a team of front line representatives, focusing on coaching/engagement, Quality, Inventory Management and helping evolve member experience. Our lead

Your Role The Blue Shield Promise Health Clinics team is responsible for providing comprehensive, communicative, and collaborative healthcare to our members that is of the quality that we would want for our own family members . The Licensed Clinical Social Worker Behavioral Health will report to the Clinic Medical Director. In this role you will work with primary care pro

Your Role This position is located in our Lincoln Heights Community Resource Center Location & require employee to work 5 days per week in the Lincoln Heights Community Resource Center The Community Resource Center (CRC) team is responsible for managing the Blue Shield Promise Health Plan Information Resource Center (IRC) and jointly operating CRCs throughout Los Angeles

Your Role The wave of Large Language Models and Generative AI has burst onto the scene, requiring companies to quickly adapt to harnessing the power of these new technologies, while maintaining a secure and compliant environment and simultaneously continue using more traditional AI / machine learning techniques. The enterprise wide Data & Analytics team at Blue Shield of

Your Role The Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post service or claim denial. The Appeals and Grievances RN Senior will report to the Manager of the Appeals and Grievances team. In this role you will perform accurate and timely clinical review of member initiated ap

Your Role The IFP Install and CEC team supports our consumer line of business by managing the eligibility and reconciliation of our IFP membership for both on and off exchange membership. The Enrollment Processor, Intermediate will report to the Operations Supervisor, IFP Install. In this role you will review and reconcile eligibility data, support our vendor team with cl

Your Role Pharmacy Readiness and Incident Management (PRIM) is a governance process and team within Pharmacy Services that logs, manages, and communicates the impact and resolution of all pharmacy impacting issues. PRIM proactively monitors and communicates Pharmacy Operational Readiness activities, milestones, and risk mitigations for both Blue Shield of California (BSC)

Your Role As a DevSecOps Engineer in IT Quality Engineering Organization, you will play a crucial role in ensuring the security and quality of software products. As part of a Center of Excellence, your primary responsibility will be to establish best practices and standards for DevSecOps methodologies, ensuring a secure and seamless transition to the cloud environment. Yo

Your Role The Senior level Developer of the Client Personalization team is responsible for application service level achievement and customer satisfaction of Blue Shield of California's Salesforce Health Cloud capabilities. This developer creates, configures, and manages Salesforce applications and related components and will be accountable for delivering BSC's desired bu

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 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 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 Principal Sourcing Specialist (Supplier Procurement/Contracting) is responsible for the management and execution of the enterprise sourcing process including supporting the b