Director of Medicare Operations

Your RoleAs a key member of the Utilization Management team at Blue Shield of California, the Director, Medicare & Medi-Cal Utilization Management plays a critical role in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership.This individual will lead the development of UM...

About the RoleThe Director of Medicare and Medi-Cal Utilization Management will play a critical role in the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives.Key ResponsibilitiesDevelop and implement utilization management strategies to ensure timely and cost-effective care for patients.Lead...

Job Title: Medicare Prior Authorization RNAt Blue Shield of California, we are seeking a skilled and experienced Medicare Prior Authorization RN to join our Utilization Management team. As a key member of our team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key Responsibilities:Conduct thorough...

About the RoleBlue Shield of California is seeking a highly skilled Medical Director Operations Lead to provide clinical leadership within the Medical Management department. This role will oversee clinical review activities, including utilization management, appeals, and grievances. The successful candidate will have a strong background in healthcare...

Your RoleThe Medical Management team at Blue Shield of California is dedicated to ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California. As the Medical Director, Utilization Management (CalPERS), you will report to the Vice President, Medical...

Your RoleThe Medical Director, Operations (Behavioral Health) will report to the Senior Medical Director, Behavioral Health at Blue Shield of California. In this role, you will have core responsibilities in the areas of psychiatric inpatient concurrent review, pre- and post-service utilization review, and collaboration with Nurse Care Managers.Key...

Job SummaryThe Medical Director, Utilization Management will serve as a key member of the Blue Shield of California Promise Health Plan's utilization management review team. This role reports to the VP, Medical Management or their designee.Key ResponsibilitiesReview and make determinations regarding all member and provider requests for service, including...

About the RoleWe are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make...

About the RoleThe Medical Director, Utilization Management plays a critical role in ensuring the delivery of high-quality, cost-effective healthcare services to our members. As a key member of the Blue Shield of California Medical Management team, you will be responsible for reviewing and making determinations regarding member and provider requests for...

Job SummaryKimball Equipment is seeking an experienced Operations Director to oversee the company's operational management systems, processes, and best practices. The ideal candidate will have a strong background in organizational effectiveness and operations management, with experience in equipment dealership operations preferred but not required.Key...

Your Role:As a Clinical Appeals and Grievances Specialist at Blue Shield of California, you will be responsible for reviewing member appeals and grievances related to Medicare and Medi-Cal benefits. This role requires a strong understanding of clinical guidelines, including National Coverage Determination (NCD) and Local Coverage Determination (LCD)...

Job SummaryThe Senior Utilization Management Nurse will be responsible for performing first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare. This role requires a strong clinical judgment and...

Your RoleBlue Shield of California is seeking a seasoned leader to oversee the behavioral health program for all product lines. The Director of Behavioral Health will report to the Senior Director of Care Management.In this role, you will be the subject matter expert and leader for utilization management and case management behavioral health.Your WorkBe...

Job Title: Operations ManagerKimball Equipment is seeking a highly skilled and experienced Operations Manager to join our team. As a key member of our leadership team, you will be responsible for overseeing the day-to-day operations of our organization, ensuring that all activities are carried out in a cost-effective and efficient manner.Key...

Job Title: Operations ManagerAt Fairfield Inn & Suites Rancho Cordova, we are seeking an experienced Operations Manager to join our team. As a key member of our management team, you will be responsible for ensuring the smooth operation of our hotel, providing exceptional guest service, and driving business results.Key Responsibilities:Supervise and...

Company Overview Blue Shield of California is a leading health plan that provides high-quality, affordable health care services to its members. With a strong commitment to innovation and customer satisfaction, Blue Shield of California is dedicated to improving the health and well-being of its members. Job Summary We are seeking an experienced...

About the RoleThe Senior Medical Director, Behavioral Health will lead the Behavioral Health Medical Director team at Blue Shield of California. This role is responsible for providing clinical leadership and subject matter expertise in behavioral health. Key ResponsibilitiesProvide oversight of the clinical behavioral health program, including managing the...

Your RoleThe Commercial Post Service Review team at Blue Shield of California is responsible for clinically reviewing claims that are the result of either a preservice or claim denial. As a Senior Clinical Reviewer, you will report to the Manager, Post Service, and perform accurate and timely clinical review of post service claims for the CalPERS...

Job SummaryBlue Shield of California is seeking a highly skilled Medical Director, Utilization Management to join our team. As a key member of our Medical Management department, you will play a critical role in ensuring our Medi-Cal members receive the right level of care, at the right time, and at the right cost.The ideal candidate will have a strong...

About SolidigmSolidigm is a global leader in the memory industry, with a presence in Asia, Europe, and the Americas. We are a multibillion-dollar company that combines the best of technology, people, and operational scale to drive innovation and growth. Our mission is to be the go-to partner for optimized data storage solutions, and we are seeking a talented...