Blue Shield of California Jobs

Your Role The Senior Director, Risk Adjustment and Medicare STARs role will lead the Medicare Risk Adjustment and Stars programs, two functions that drive appropriate revenue and thus critical to the growth and financially viable and competitive Medicare products. This leader will develop the programs and take accountability by partnering with C-suite executive and cross functional senior leaders across multiple health plans (national) for better encounter data and member quality outcomes (in...

Your Role The Medical Care Programs team is responsible for managing vendor-delivered programs to manage care and deliver benefits for our members. The Program Manager, Principal will report to the Senior Manager, Medical Care Programs. In this role, you will manage transportation benefits for Blue Shield of California. You will be a member of a small team responsible for managing the vendor that provides transportation to members. You will be responsible for driving value, managing performan...

Your Role The Senior Program Manager, 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 requirements with state/federal r...

Your Role The Utilization Management team processes Medical and Behavioral Health prior authorization and concurrent review requests for BSC membership. The Program Manager, Consultant will report to the Sr. Manager Behavioral Health Utilization Management. In this role you will oversee and ensure Utilization Management compliance with federal and California State mental health parity requirements.Your Knowledge and Experience Requires a bachelor’s degree or equivalent experience Requires at ...

Your Role The Clinical Program Manager, Principal in collaboration with the Regional Medical Director and internal Blue Shield of California teams will be responsible for collaborating with all externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction) with a focus on execution to drive 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 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 business in making effective sourcing decisions. This person executes and delivers value through strategic, operational, and...