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 Medical Director, Commercial is a key member of the Medical Management and Operations staff within Health Care Services. This is a front line utilization management position that has core responsibilities in the areas of pre and post service utilization review, and collaboration with RN Case and disease managers.This director position will report to the Medi

Your Role Join Blue Shield's dynamic Enterprise Learning organization, which develops learning solutions to ensure employees can perform their jobs effectively to further our mission. As a IT Learning Developer, Senior you will serve as a strategic partner to talent mobility through innovative learning strategies and solutions. The IT Learning Developer, Senior will repor

Your Role The Compensation team is an in house center of expertise and consulting team and provides leadership and guidance in the development and delivery of effective compensation strategies and policies that support BSC's goals, and are in alignment with enterprise values, philosophy and strategic direction.. The Senior Compensation Analyst will report to the Senior Ma

Your Role The Actuarial Provider Strategies team helps design and implement value based care (VBC) payment models, which include Accountable Care Organizations (ACOs) and other innovative alternative payment models (APMs) to improve the affordability and quality of care our members receive. The Experienced Actuarial Analyst will report to the Senior manager of Actuarial P

Your Role The Corporate Communications team supports Blue Shield of California's reputation with both internal and external audiences through employee engagement, media and executive visibility. The Senior Communications Manager will report to the Senior Director of Corporate Communications. In this role you will lead a team supporting the Chief Human Resources Officer an

Your Role The People and Engagement (P&E) Enterprise Planning, Principal will report to the Director, P&E Strategy and Planning. In this role you will support the creation, ongoing execution and reporting of P&E's enterprise impacting plans and initiatives, and maintain alignment with our people strategy and P&E annual planning efforts. This will include Blue Shield's hum

Your Role The Cost of Healthcare Trendsetters & Pharmacy Support team analyzes and provides emerging healthcare cost trend drivers. The Medical Informatics Analyst IV will report to the Actuarial Manager. Your Work In this role, you will Conduct independent analysis of high complexity under minimal supervision and guidance Develop analytical methods so that they may be su

Your Role The Sr. Director, Legal Counsel will be a member of Blue Shield's Law Department and will be a leader in the company. The Law Department partners with the company's business leaders to embrace legal and ethical behavior in the achievement of the company's mission. This team is highly regarded within the company and respected by management. It is comprised of top

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 Actuarial Reserving team develops Incurred but Not Reported (IBNR) reserve models and reporting while considering the impacts of emerging operational and trend dynamics on reserve levels . The Actuarial Analyst, Experienced will report to the Senior Manager of Reserving. In this role you will collaborate with partners in Accounting, Operations, IT, and other

Your Role The Network Trend Analytics team is responsible for performing financial modeling and analytics for provider contract negotiations for hospitals and ambulatory surgery centers. The Associate Actuarial Analyst will report to the Senior Manager. In this role you will be applying your analytical toolset to project future unit cost trends and drive the development o

Your Role This role resides within the IT Applications' Transformation, Operations & Customer Experience team. The candidate will report to the IT Director, Solution & Delivery Lead in the Portfolio. In this role you will be responsible for leading, facilitating, and driving continuous improvement of Agile practices for the team or teams that you'll be supporting. The Por

Your Role The Delegation Oversight Utilization Management team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting that track and compare patters of delegated entities. The Delegation Operations Nurse Auditor LVN Experience

Your Role The Innovation Analyst, Consultant is responsible for supporting the improvement and maintenance of our integrated enterprise strategy to execution process and supporting initiatives designed to provide strategic thought leadership to business leaders across the enterprise to address ambiguous problems and opportunities. This role will serve as a change agent, l