Blue Shield of California Jobs in the United States
Blue Shield of California
Rancho Cordova, CA
The Senior Medical Director, Behavioral Health will service as clinical, regulatory and quality improvement resource and clinical behavioral health thought leader within the organization and externally with provider group and community partners. Review pre- and post-service behavioral health service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP (spell out acronym) medical policy, as well as legal and regulatory requirements.
Blue Shield of California
$87230 - $130900 undefined
Long Beach, CA
In this role, you will: Perform retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEP . Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
Blue Shield of California
Long Beach, CA
Produce monthly provider and/or employer group specific reports based on HEDIS measures in alignment with reporting quality ratings systems such as NCQA Stars/Accreditation, Medicare Stars, Medi-Cal Managed Care Accountability Sets, Quality Transformation Initiative and Quality Rating System. In this role you will provide data, analytic and reporting support for the Clinical Quality Department to improve Blue Shield of California and Promise Health Plan quality performance for regulatory and accreditation requirements including National Committee for Quality Assurance, Centers for Medicare and Medicaid and Department Health Care Service.
Blue Shield of California
Woodland Hills, CA
Care Managers perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
Blue Shield of California
$87230 - $130900 undefined
Long Beach, CA
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. Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team .
Blue Shield of California
$109120 - $163680 undefined
Long Beach, CA
The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team .
Blue Shield of California
$87230 - $130900 undefined
Long Beach, CA
In this role, you will: Perform care management/care coordination for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medi-Cal and CCS/EIES/DDS/ECM Eligibility guidelines. Ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity and determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost -appropriate DC planning.
Blue Shield of California
$87230 - $130900 undefined
Rancho Cordova, CA
Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. Prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination and communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirements.
Blue Shield of California
$20.82 - $29.15 undefined
Long Beach, CA
In this role you will provide telephonic social services support and resource referrals for high acuity Blue Shield Promise members, in addition to administrative support to the Social Services Management Team. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.