Your Role The Enterprise Architecture & Health Innovation team is responsible for setting the overall technical direction, enterprise architecture, health innovation, and automation for Blue Shield of California. The Principal Engineer, Enterprise Architect will report to the Director of Technology and Data Architecture. In this role you will be responsible for defining t

Your Role The Promise Health Plan Medical Director provides clinical leadership within the Blue Shield Promise Office of the CMO. The Medical Director's duties include oversight and management of the clinical processes in support of member health initiatives, utilization management, care and case management, and clinically related functions. These functions include perfor

Your Role Leads and manages integrated audits and advisory engagements to provide an information technology focus on financial and operational audits. Assesses the design and effectiveness of internal controls for business processes, financial reporting and measurement activities, related applications and automation solutions, and enterprise wide data processing environme

Your Role The Enterprise Architect, Consultant is a strategic individual contributor role reporting to the Director in Enterprise Architecture. This individual will be a senior member of the Enterprise Architecture organization responsible for developing enterprise architecture strategy across the company. This individual will be responsible for delivering the corporate E

Start Date June 26, 2023 or July 10,2023 Our Senior Markets Customer Experience Teams receive incoming telephone calls from both our 65+, Medicare and Medicare Supplement Senior members. The Senior Markets Call Center is open 7 days a week, 7 00 a.m. 8 00 p.m., including holidays. If hired, you will be required to attend and complete a paid, 4 10 week mandatory training c

Your Role The Information Security Risk Managementteam includes the IT Risk Assurance program for technology risk identification to risk consequence management. The Information Security Engineer, Seniorwill report to the Senior Manager, IT Risk Assurance. In this role you will be a key individual contributor to the IT Security team and Blue Shield of California's overall

Your Role The Clinical Compliance Consultant, 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 Consultant is also responsible for managing changing UM requirements driven by contractual changes or All Plan Letter requirements. The successful cand

Your Role The Product Marketing team collaborates with key partners in Product Management, Sales, and Marketing to bring differentiated and desirable health plan solutions to the market. The Product Marketing Strategist, Principal will report to the Product Marketing Team Lead. In this role, you will leverage your understanding of market and customer demands, technology t

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the f

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the f

Your Role The Pharmacist, Consultant Drug Utilization Review is primarily responsible for supporting the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process and supports the clinical components of the Pharmacy Services Benefit Management Drug Authorization Program by ensuring that evidence based clinical decisions of the Blue Shield of California P

Your Role The Utilization Management team facilitates the review of requests for medical necessity to assure that care is provided to our members timely, at the correct level of care with quality and cost effectiveness standards. The Utilization Management Nurse Consultant will report to the Utilization Management Manager. In this role you will be an individual with advan

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 Medical Informatics Analyst, Senior will report to the

Your Role The Network Performance Analysis and Contracts (NPAC) team is part of the HCQA Division and focuses on provider network performance analysis, reporting, and consulting. The NPAC team is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of Blue Shield's network of physicians, hospitals, ambulat

Your Role The membership back end enrollment team is responsible for enrolling members, groups, and brokers into Blue Shield of California. The Application Developer, an Experienced candidate will report directly to the Low Code Center Of Excellence Manager but will perform work within the membership back end enrollment agile Service delivery team to achieve transformatio