Blue Shield of California Jobs

Your Role The Provider Operations team is responsible for procurement, processing and enablement of consumption of provider and practitioner add, change or terminate requests data demographics and attributes. Using a combination of automated capabilities and manual procedures, the department supports all provider types and all lines of business organization wide. The Software Configuration Manager will report to one of the Senior Managers within Provider Operations. In this role you will be a...

Your Role The Medical Care Programs team is responsible for managing programs that support members with their health care, drive cost of healthcare savings, and improve quality. The Program Manager, Consultant will report to the Senior Manager, Medical Care Programs. In this role you will manage a critical, cross-functional cost of healthcare taskforce, focused on a specific market segment. You will be responsible for impacting the cost of healthcare trend by direct intervention and by identi...

Your Role Reporting to the Vice President, Medicare, this national role of the Sr. Director, Quality (Medicare Stars) will lead and manage the strategic direction, development and execution of quality improvement programs for Medicare health plans. This role is crucial in ensuring that a health plan meets or exceeds regulatory standards, such as those set by the Centers for Medicare Medicaid Services (CMS) and achieves high ratings in Medicare’s Star rating system. In this role, strategic vis...

Your Role The Medi-Cal Program Support team leads Medi-Cal business process excellence and decision support. The Program Manager, Consultant will report to the Senior Manager in the Medi-Cal Program Support team. In this role you will support the Senior Manager in developing new and updating training content and oversee the Medi-Cal training and education sub portfolio to ensure access to current Medi-Cal training and pertinent Medi-Cal knowledge in accordance with contractual and regulatory ...

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 Specialty Care Programs team within the Clinical Strategy and Programs department is responsible for managing programs focused on providing high-quality care and services to members when and where they need them. The Program Manager, Principal will report to the Director, Specialty Care Programs. In this role you will contract, design, and implement a new field-based care program and oversee ongoing program operations. Your Work In this role, you will: Communicate with vendors a...

Your Role The Clinical Compliance Principal, Medical Care Solutions is responsible for developing and maintaining the team’s audit playbook for all lines of business for all regulatory and mock audits. Clinical Compliance Principal is also responsible for managing changing UM requirements driven by contractual changes or All Plan Letter requirements. The successful candidate will work with internal and external stakeholders understanding regulatory requirements, file preparation, letter and s...

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...

Your Role The Blue Shield Behavioral Health Clinical Strategy and Programs team works with internal and external business and clinical partners to develop, execute, and evaluate Blue Shield of CA’s strategy for behavioral health and addiction medicine, which we refer to as “Behavioral Health, Re-Imagined.” This Program Manager Clinical, Principal role will report to the Director of Behavioral Health Clinical Strategy and Programs. In this role you will work with cross-functional partners to d...

Your Role The MCS Post Service Team has responsibility to oversee and manage specific vendor relationships focused on providing high quality care and services that support different areas of the business. The Program Manager, Senior will report to the Program and Project Senior Manager. In this role you will provide compliance oversight, updates, and contract adherence while partnering with cross-functional stakeholders. Your Work In this role, you will: Provide overall program leadership, gu...

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 Strategic Planning and Performance team supports the Core and Small Group Sales organization that manages all group business up to 2,999 members. The Program Manager, Senior - Core and Small Group will report to the Director of the Strategic Planning and Performance team. In this role you will work cross functionally to develop and drive business solutions and advocate for Core and Small Group across the enterprise. The Program Manager, Senior will identify and lead projects to ...

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 programs that support members with their health care, drive cost of healthcare savings, and improve quality. The Clinical Program Manager, Consultant will report to the Senior Manager, Medical Care Programs. In this role you will manage a critical, cross-functional cost of healthcare taskforce, focused on a specific employer client. You will be responsible for impacting the cost of healthcare trend by direct intervention and...

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 Senior Manager, Procurement Contracting role will report to the Director, Contracting. In this role you will be responsible for the management, prioritization and execution of the enterprise contracting initiatives and process including supporting the business in making effective sourcing decisio...