Medical Operations Director for Medicare and Medi-Cal

About the Role">We are seeking a skilled Healthcare Operations Director to lead our Medicare and Medi-Cal Utilization Management team at Blue Shield of California. As a critical member of our organization, you will play a key role in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal...

About the Role:The Director, Medicare & Medi-Cal Utilization Management plays a pivotal part in the success of Blue Shield of California by overseeing utilization management and care coordination for Medicare and Medi-Cal beneficiaries.This position involves managing prior authorization processes, developing UM strategies using data analytics, and ensuring...

Job OverviewWe are seeking an experienced Utilization Management Executive to lead our efforts in managing Medicare and Medi-Cal utilization. This role plays a vital part in ensuring the success of Blue Shield of California.The ideal candidate will have a proven track record in driving organizational change management, with excellent relationship and...

Job SummaryWe are seeking a seasoned Healthcare Operations Director to oversee Utilization Management and care coordination for Medicare and Medi-Cal beneficiaries at Blue Shield of California. As a key member of our team, you will be responsible for managing prior authorization processes, developing UM strategies using data analytics, and ensuring...

Job SummaryWe are seeking an experienced Clinical Compliance Director to join our team at Blue Shield of California. This role will oversee the development and maintenance of our audit playbook for all lines of business, ensuring compliance with regulatory requirements.About the RoleDevelop new perspectives and innovative approaches on existing problems;...

Job OverviewThis role is a critical component of Blue Shield of California's success in achieving its goals and objectives. As a key member of the Utilization Management team, you will play a pivotal part in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership.

**Overview**At Blue Shield of California, we are committed to delivering exceptional healthcare services. We are seeking a highly skilled Medical Director, Utilization Management Specialist to join our team.**Salary Range**The estimated salary range for this role is $165,990.00 - $248,930.00 per year, based on experience and location.**Job Description**As a...

Job SummaryWe are seeking a highly skilled Strategic Business Solutions Consultant to join our team at Blue Shield of California. This role will play a critical part in driving business growth and improving operational efficiency across our Commercial, Medi-Cal, and Medicare lines of business.

Job Summary:We are seeking a highly skilled Healthcare Operations Manager to join our team at Blue Shield of California. This role will oversee the Utilization Management Prior Authorization team, ensuring accurate and timely prior authorization of designated healthcare services.The successful candidate will have a bachelor's degree or equivalent experience,...

Job SummaryThe Medical Director of Behavioral Health plays a pivotal role in ensuring the quality and efficiency of mental health services. As a key member of our team, you will oversee pre- and post-service utilization reviews, collaborate with healthcare providers to deliver high-quality care, and train care management staff to ensure compliance with...

OverviewThe Blue Shield of California organization is dedicated to improving the health and well-being of our members through a combination of innovative medical policies, quality care management, and telephonic consultations. As a Medical Director for Behavioral Health, you will play a vital role in ensuring that our members receive timely access to...

About Blue Shield of CaliforniaWe are a leading healthcare provider in California, committed to delivering high-quality medical services to our members.Job Title: Medical Management CoordinatorJob Type: Full-timeSalary Range: $20.47 - $28.66 per hourAbout the RoleThe Clinical Services Coordinator (CSC), Intermediate will support clinical staff in their...

Company Overview">Blue Shield of California is a leading health insurance company dedicated to providing high-quality healthcare services to its members. The organization values innovation, excellence, and teamwork in achieving its goals.Job Summary">We are seeking an experienced Healthcare Executive Director for Utilization Management to lead our team in...

Your RoleThe Clinical Services Coordinator (CSC) will report to the Supervisor of Clinical Services Intake and be responsible for supporting clinical staff day-to-day operations for Promise (Medi-Cal) or Commercial/Medicare lines of business.Work EnvironmentYou will work in a production-based environment with defined production and quality metrics. You will...

The Clinical Compliance Principal oversees the development and maintenance of audit playbooks for regulatory compliance across multiple lines of business. This role requires strategic engagement with internal and external stakeholders to adapt to changing compliance requirements and manage complex audit processes.About UsAt Blue Shield of California, we are...

About the RoleWe are seeking a highly skilled Medical Director, Behavioral Health to join our team at Blue Shield of California. As a key member of our Medical Management team, you will play a critical role in ensuring the quality and efficiency of mental health services.ResponsibilitiesOversee pre- and post-service utilization reviews to ensure compliance...

About the RoleBlue Shield of California and Promise Health Plan are seeking a skilled Clinical Quality Analytics and Informatics professional to join our team. As a Clinical Quality Analyst - Senior, you will play a critical role in delivering high-quality clinical analytics and informatics to support our mission of providing excellent member-centered...

About the RoleWe are seeking a seasoned Behavioral Health Care Leader to join our team at Blue Shield of California.Job SummaryThe Medical Director, Behavioral Health will lead our medical management efforts to ensure that we stay at the forefront of medical, medication, and payment policy innovation. This role will require expertise in clinical...

At Blue Shield of California, we are dedicated to providing exceptional mental health services to our members.About the RoleWe are seeking a highly skilled and experienced Medical Director, Behavioral Health to join our team. As a key member of our medical management team, you will play a critical role in ensuring the quality and efficiency of our mental...

**Job Summary**Blue Shield of California seeks a highly skilled Strategic Business Development Specialist to join our team. This role is responsible for providing complex analytical support, leading business planning initiatives, and developing data-driven solutions to drive business growth.**Key Responsibilities:**Provide advanced analytical support through...