Your Role The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, partic

Your Role The Corporate Citizenship Sustainability team sets environmental strategy, standards and targets, collects and analyzes environmental data, conducts environmental reporting (including greenhouse gas inventory and climate related risk/resilience), and oversees mitigation, adaptation and climate leadership work along Blue Shield's value chain. The Corporate Citize

Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Northern California for all Blue Shield products. You will be responsible for compre

Your Role The Clinical Quality Analytics and Informatics team delivers best in class clinical quality analytics and informatics to enable high quality and affordable member centered care. Our data, intelligence, and actionable insights help drive quality strategy, performance improvement, and regulatory reporting. The Clinical Quality Analyst Senior will report to the Cli

Your Role The Medicare Appeals and Grievances team is responsible for compliance processing of Medicare appeals and grievances. The supervisor will report to the Sr. Manager for Medicare Appeals and Grievances. In this role you will manage the daily, short term, and/or long term activities of the customer service and operations teams to ensure alignment with service level

Your Role The IT Business Operations team plays a critical role in enhancing business and IT collaboration through a Portfolio based model. The System Analyst, Consultant will report to the Senior Manager, IT Product Management. In this role you will analyze data at a team and portfolio level, in a manner to tell stories to leadership. Your Work In this role, you will For

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 Contracting Specialist, Senior will report to the Manager, Procurement Contracting. This role is responsible for every phase of contract development from integrating relevant

Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Senior will report to the Director, Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products. You will be responsible for comprehensive m

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Registered Nurse Case Manager will report to the FEP Department M

Your Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Operations for the Transitional Care Services Team which manages our Medi Cal member population. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficientl

Your Role As a DevSecOps Engineer in IT Quality Engineering Organization, you will play a crucial role in ensuring the security and quality of software products. As part of a Center of Excellence, your primary responsibility will be to establish best practices and standards for DevSecOps methodologies, ensuring a secure and seamless transition to the cloud environment. Yo

Mandatory Training In Person at our Rancho Cordova, CA Office Your Role As a Customer Service Representative (CSR), you are in charge of upholding our mission of providing a service worthy of our family and friends. You are empowered to provide members with peace of mind that their current issue is resolved and that none are on the horizon. Successful CSRs deliver an effo

Your Role The Care Management Department, which oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must posses

Blue Shield is embarking on an exciting new collaborative partnership with a fellow health plan. We will play a supporting role in their day to day contact center operations by supporting inbound call inquiries from their members and providing a high quality experience. This newly created team of contact center agents will report directly to the Operations Supervisor supp

Your Role TheDigital Member Experienceteamis driving better access to healthcare for our members by reimagining our digital customer experience. The Principal Product Manager will report to the Sr. Manager, Product Management Digital Member Experience. In this role you willleverage your expertise in product management and consumer experiences to help drive member satisfac