Blue Shield of California Jobs

Your Role The Clinical Operations Oversight team is responsible for managing key and critical health plan program functions and processes. The Program Manager, Consultant will report to the Senior Manager, Quality Governance. In this role you will be responsible for the coordination and implementation of the overarching clinical operations committee structure and governance, and ensuring the readiness of related documentation, which may be used as evidence of operational oversight compliance ...

Your Role The Utilization Management Concurrent Review team ensures accurate and timely authorization of designated healthcare services clinical review determinations for Medicare Line of Business. The Manager, Utilization Management Nurse Management will report to the Director, Utilization Management Nurse Management. In this role you will be managing a high functioning team, have direct oversight of day-to-day operations and participate in process improvement/cost of health care initiatives...

Your Role The Enterprise Architecture Innovation team helps manage and align Blue Shield of California's technology infrastructure with its business goals, ensuring that independently conceived and deployed solutions do not lead to unnecessarily complicated and expensive siloed systems. It defines the enterprise business technology capabilities and their relationships to run, grow, and transform the business. The Enterprise Architect, Principal will report to the Sr. Director Enterprise Archi...

Your Role The Health Care Solutions Division is responsible for developing, maintaining, and managing the relationship with Blue Shield's network of physicians, hospitals, ambulatory surgery centers, HMO IPAs, and medical groups. Our team, Network Performance Analysis and Contracts (NPAC) is part of the Network Management and Provider Partnerships department and focuses on provider network performance analysis, reporting, and consulting. The NPAC team is responsible for developing analytics a...

Your Role The Medicare Star Performance team is responsible for achieving sustainable Medicare Advantage and 4 Star performance . The Program Manager, Consultant – Member Experience will report to the Director of Medicare Star Strategy and Performance. In this role you will implement programs and processes designed to improve member experience within our Medicare Advantage delivery systems. You will also be responsible for leading market initiatives to address member perceptions and enhance B...