Healthcare Consultant

5 days ago


El Dorado Hills, California, United States Blue Shield of California Full time

At Blue Shield of California, we are dedicated to providing quality healthcare services to our members. As a Healthcare Consultant - Case Management, you will play a critical role in ensuring that our members receive the best possible care.

About the Role

In this position, you will be responsible for managing member needs for specific clinical programs and care coordination. You will perform clinical reviews, assessments, and evaluations of medical services to ensure compliance with established guidelines and protocols.

You will also be responsible for assisting in the improvement of operational processes and implementation of new regulatory requirements. This will include working closely with the CSP Managers to develop and implement effective solutions.

The ideal candidate will have at least 7 years of prior relevant experience, including a minimum of 4 years' experience in Medi-Cal Clinical Review, Case Management, and Care Coordination. A minimum of 2 years' experience with Child Health Programs CCS, EI, ES, DDS, EPSDT, CHDP is preferred.

The pay range for this role is: $77,990.00 to $116,930.00 for California.

About Our Company

Blue Shield of California is a leading health plan provider in the state, dedicated to delivering high-quality healthcare services to our members. We are committed to improving the health and well-being of our communities through innovative programs and partnerships.

Required Skills and Qualifications
  • Bachelor's degree or equivalent experience required
  • Current California LVN License required
  • At least 7 years of prior relevant experience
  • Minimum of 4 years' experience in Medi-Cal Clinical Review, Case Management, and Care Coordination
  • Minimum of 2 years' experience with Child Health Programs CCS, EI, ES, DDS, EPSDT, CHDP preferred


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