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 Workforce Management team partners with operations to ensure the contact centers are staffed appropriately to meet KPI's while looking for opportunities to gain efficiency. The Workforce Optimization Analyst will report to the Sr. Manager of WFM. In this role you will analyze contact center trends, including call volumes, offline inventory, and call patterns

Your Role This position is located in our West Los Angeles Community Resource Center Location & require employee to work 5 days per week in the West Los Angeles 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 Angele

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 Managed Care Finance team administers the financial terms and conditions of our capitated contracts with IPA/Medical Groups, Hospitals, and Vendors. The Financial Analyst, Experienced will report to the Manager of Managed Care Finance. In this role you will be performing provider contract analysis, financial research, preparing financial forecasts, analyzing

Your Role The Information Security team is responsible for providing cyber security services to Blue Shield of California that enable secure product development and operations. The Director of Information Security will report to the Sr. Director . In this role you will you will lead a team responsible for designing, implementing, and maintaining security capabilities that

Blue Shield of California's mission is to ensure all Californians have access to high quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To fulfill our mission, we must ensure a diverse, equitable, an

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 Third Party Application Solutions personnel within the Software Development Centers Of Excellence team perform hardware and software system administration as well as set quality expectations. The Senior Application Developer & System Administrator will report to the Centers Of Excellence Senior Manager. In this role you will execute hands on patching and upg

Your Work In this role, you will Carry out administrative, analytical or procedural tasks with high degree of autonomy Handle administrative matters, in the absence of, or on behalf of, the manager Provide administrative oversight of third party relationships through implementation of designated systems, routine monitoring of performance, and tracking of goods and/or serv

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,