Utilization Management Manager The Utilization Management team reviews inpatient stays and prior authorization for our members and correctly applies the guidelines for nationally recognized levels of care for both our Medi-Cal and Medicare populations. The Utilization Management
Program Manager, Consultant The Behavioral Health Network Management, Healthcare Quality and Affordability (HQA) team is responsible for the development and maintenance of all Behavioral Health provider networks, including vendor relationships necessary to provide our members and clients
Senior Manager, Program and Project Management - Pharmacy Vendor Management The Pharmacy Vendor Management team supports Pharmacy Strategy and Operations in managing the vendor contracting process, vendor governance model, vendor performance, vendor escalations, and various operational level
Sr. Manager, People Technology and AI Enablement The People & Engagement Technology team is a critical member of the Corporate Platform in the IT Applications organization and is responsible for providing technical and functional leadership for multiple
Digital Personalization Product Manager The Platform Strategy & Operations team, within Blue Shield of Californias Intelligent Automation & AI organization, owns BSCs member intelligence and orchestration layerunifying member data, generating predictive insights, and activating personalized experiences across
Project Manager, Senior - Group Medicare (Non-IT) The Group Medicare team is responsible for Client & Stakeholder Management, Retiree & Member Support Operations, Project Management & Execution, Compliance, Quality, & CMS Readiness, Data, Reporting & Continuous Improvement.
Senior Principal, Strategic Account Manager The Customer Experience organization is responsible for ensuring Stellarus most critical customers achieve measurable, sustained value from the platform and maintain long-term trust and partnership with the company. The Senior Principal, Strategic
Senior Manager, Project & Program Management The Healthcare Quality & Affordability (HQA) Project Management Office (PMO) team drives strategic outcomes for the HQA division and executes initiatives including schedule, scope, resource and financial management. The Senior Manager, Project
Product Manager, Consultant - Automation & AI Business Delivery The Product Manager, Consultant - Automation & AI Business Delivery reports to the Transformation Sr. Director. They will lead design and delivery of automation and AI-driven solutions that streamline
Pharmacy Operations And Stabilization Program Manager Consultant The Pharmacy Operations and Stabilization team provides management and end-to-end oversight of all Pharmacy operations, production stabilization issues, and drives issues from identification to resolution within a matrixed environment. The
Project Manager Consultant The Enterprise Mandates Delivery team is responsible for transforming new laws into audit-ready projects with defined ownership, scope, timelines, and funding, and oversees implementation through the full project lifecycle, including transition to operational owners.
Population Health Senior Manager The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers
Principal Internal Controls Advisory Services The Internal Controls Advisory Services (ICAS) team supports Blue Shield of California in strengthening enterprise-wide internal controls, risk management, and governance practices across business and technology functions. The Principal will report
Utilization Management Nurse, Senior The Utilization Management team manages accurate and timely prior authorization and inpatient stays reviews for our members and correctly applies the guidelines for nationally recognized levels of care for our Shared Services
Pharmacist, Consultant The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team
Senior LVN, Care Manager The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior LVN, Care
Tax Accountant, Senior We are currently seeking a Tax Accountant, Senior. This position will report to the Tax Director and will be responsible for assisting in the preparation of financial statement quarterly tax provision, tax projections,
Medical Director, Utilization Management Commercial Prior Authorization Review The Medical Management team ensures that Blue Shield of California (BSC) is on the cutting edge of utilization management reimagined to accelerate the development and sustainability of a
Senior Internal IT Auditor The Senior Internal IT Auditor leads and executes audit engagements, serving as a subject matter resource and ensuring high-quality audit delivery across technology and cybersecurity domains. Responsibilities In this role, you will:
Job Title Business Configuration Oversight Team Platform Administrator Consultant Job Description The Business Configuration Oversight team is responsible for overseeing configuration and delivery of projects by vendor. The Platform Administrator, Consultant will report to the IT