Blue Shield of California Jobs

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 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 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 Program Manager for Behavioral Health Initiatives, Principal Level, will report to the Director of Clinical Access Programs in the Blue Shield Promise Office of the Chief Medical Officer (CMO). The program manager will focus upon the Medi-Cal population, supporting strategic initiatives that seek to enhance quality behavioral healthcare delivery and outcomes, as well as integration of behavioral health into medical healthcare delivery environments. The program manager will desig...

Your Role The Business Operations team is responsible for ensuring appropriate strategic planning and oversight over Clinical Quality. The Strategic Planning and Performance Program Manager will report to the Director, Clinical Quality. In this role, you will be responsible for strategic alignment and integration across projects/programs in support of Clinical Quality and administrative efficiency. Define projects and initiatives required to support teams to ensure on-time implementation, wit...

Your Role The Communications and Corporate Citizenship team is responsible for employee, media, employee giving and climate and sustainability. The Program Manager, Principal will report to the VP, Communications and Corporate Citizenship. In this role you will apply program management expertise to support the Corporate Communications teams with successful execution of initiatives and programs; this will include thought partnership, implementation planning, and milestone tracking and reportin...

Your Role The Senior Manager, Program and Project Management, NCQA Accreditation, is responsible for the coordination and execution of health plan wide accreditation activities, including both NCQA Health Plan and Health Equity Accreditation, and for coordinating with the Quality Governance team to ensure alignment on operational oversight activities, especially as related to regulatory survey preparation. This includes partnering with other operational leaders to ensure alignment of NCQA req...

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...