Blue Shield of California Jobs

Your Work As the Program Manager, Principal, Product Strategy, you will play a central role in supporting the strategic development, evaluation, and execution of our behavioral health product portfolio. Working closely with the Director of Behavioral Health Product, and in collaboration with the Director of Partnerships Programs, you will help translate strategy into execution across multiple initiatives that span clinical, technical, and policy domains. This is a cross-functional role that b...

Your Work The Pharmacy Performance team is a shared services team supporting Pharmacy Strategy and Operations in a variety of functions including, but not limited to, program and project management, contract management, vendor management, pharmacy readiness and incident management, pharmacy infrastructure, and pharmacy compliance. The Program Manager, Principal will report to the Director of Pharmacy Performance. This position will support the Clinical Pharmacy Program by ensuring that initia...

Your Role The Pharmacy Services team is redefining how Blue Shield offers high quality, affordable, safe and convenient access to necessary prescription drugs. The Principal Program Manager, Rx Claim Exchange will report to the Senior Director, Program and Project Management. In this role you will be the business Product Owner responsible for the Rx Claim Exchange Agile Product Team. The Rx Claim Exchange Agile Product Team is one of many teams that makes up the Pharmacy Product Model. You wi...

Your Role The Behavioral Health Utilization Management (UM) team performs prior authorization and concurrent reviews by apply evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Sr. Manager, Program Management Clinical will report to the Director, Behavioral Health Utilization Management. In this role you will be responsible for managing all aspects of day-to-day operations of the Behavioral Health UM program, including adhe...

Your Role The Enterprise Architecture team translates business strategic goals into future-state capability reference architectures and execution roadmaps. The Principal AI/Data Architect will report to the Director of Enterprise Architecture. In this role you will drive the creation and maintenance of enterprise data and analytics capabilities, data reference architectures, integrated data and analytics technology roadmaps that will guide our strategic investments and enterprise strategy. Yo...

Your Role The Behavioral Health Utilization Management (UM) team performs prior authorization and concurrent reviews for members by applying evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Manager, Program Management Clinical will report to the Sr. Manager, Program Management Clinical. In this role you will be responsible for the day-to-day operations of the business unit and execution of departmental goals and objective...

Your Role Blue Shield of California is seeking a Director of Clinical Quality – Medicare Stars to lead and advance the organization’s Stars and HEDIS strategy, execution, and performance oversight. This role is critical to maintaining and improving Medicare Star Ratings and HEDIS performance by driving initiatives focused on clinical gap closure, quality improvement, health outcomes, and member experience.The Director will oversee the strategic roadmap, operational excellence, and performance...

Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key role as part of the Utilization Management team in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership. The Directo...

Your Role The Data Analytics (D A) team focuses enterprise-wide to partner with business stakeholders to apply the power of data analytics to deliver new insights and data-driven solutions to accelerate business outcomes. Reporting to the Senior Director of Care Delivery Analytics, the Senior Manager of Value Based Payments Cost Transparency Analytics is responsible for working with the key stakeholders from Finance, Actuary, Health Solutions, Product Management and others to be the Data Anal...

The Information Security Threat Detection and Response team uses advanced technologies like AI-driven threat detection and automated response platforms to monitor and respond to cybersecurity threats in real time. It acts as the hub for defense strategies, security tool integration, and rapid, data-driven decisions to protect the organization’s digital ecosystem. The Senior Manager, Threat Detection and Response will report to the Senior Director, Information Security Operations. In this role...

Your Role The Director, Provider Contracting for Medicare will report to the VP Provider Contracting. In this role, you will be responsible for leading and defining an optimal network strategy by region in collaboration with Medicare Advantage (MA) leadership and leading network design and contracting efforts for MA HMO and PPO plans. Additionally, this role will be responsible in leading and participating in strategic initiatives including, but not limited to, network expansion. We are looki...