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Utilization Management Nurse, Senior

Blue Shield Of California
Rancho Cordova, CA
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External Description Str : Your Role The Utilization Management team reviews ...
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Summary
About the job:
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 facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions....
Location:
Rancho Cordova, CA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Case Management - Nurse, Senior

Blue Shield Of California
Rancho Cordova, CA
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External Description Str : Your Role The Federal Employee Program (FEP) team ...
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Summary
About the job:
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 . The Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. Your Work In this role, you...
Location:
Rancho Cordova, CA
Job Type:
Part-Time
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
National Committee for Quality Assurance
Certified Registered Nurse
Certified Case Manager
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Case Management - Nurse, Senior

Blue Shield Of California
Cameron Park, CA
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Your Role The Care Management team will serve to support the mission of the ...
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Summary
About the job:
department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis,...
Location:
Cameron Park, CA
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Registered Nurse
Certified Case Manager
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Pharmacist, Principal

Blue Shield Of California
California
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Job DescriptionYour RoleThe Pharmacy Markets, Products, Analytics and ...
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Summary
About the job:
Strategies team is a critical area within Blue Shield Pharmacy Services to provide Product and Market strategies to support affordability and quality objectives. With the team, the Strategic Consultative Analytics area drive consultative analytics to facilitate strategy decision and opportunity identification for critical pharmacy road map initiatives. The Principal Pharmacist, Strategic Consultative Analytics will report to the Sr. Manager, Strategic Consultative Analytics. In this role you will play a key role in leading...
Location:
California
Job Type:
Full-Time
Permanent
Occupation:
Pharmacists
Career Level / Education:
Doctoral or professional degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Registered Pharmacist
Workkeys
Applied Math
6
Graphic Literacy
6
Workplace Documents
7
apply
Detailed Job Information

IT Learning Developer, Senior

Blue Shield Of California
Oakland, CA
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External Description Str : Your Role Join Blue Shield’s dynamic Enterprise ...
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Summary
About the job:
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 report to the Senior Manager of Learning Development & Shield Learns. Your Work In this role, you will: - Work with clients to assess learning needs and build learning requirements and learning plans -...
Location:
Oakland, CA
Job Type:
Full-Time
Permanent
Occupation:
Instructional Coordinators
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Social Worker, Senior

Blue Shield Of California
Rancho Cordova, CA
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External Description Str : Your Role The Care Management Clinical Social ...
Details
Summary
About the job:
Work team helps Blue Shield members with complex social determinants of health by conducting psychosocial assessments, developing care plans, and providing intensive interventions. The Care Management Social Worker will report to the Manager and/or Senior Manager of Care Management Clinical Social Work. In this role you will be assessing members and linking to appropriate levels of care, linking to community resources, and coordinating with BSC nurses as well as BSC providers. . Your Work In this role, you will: -...
Location:
Rancho Cordova, CA
Job Type:
Full-Time
Permanent
Occupation:
Mental Health and Substance Abuse Social Workers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Licensed marriage and family therapist
Licensed Clinical Social Worker
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Medical and Health Services Coordinator

Blue Shield Of California
Long Beach, CA
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Your Role The Children’s Health Program (CHP) team provides identification, ...
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Summary
About the job:
referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and approved Blue Shield Medical Policies and Guidelines which align with nationally recognized standards. You will be responsible for working daily inventory, processing medical records and requests, fax intake, referral intake,...
Location:
Long Beach, CA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Postsecondary nondegree award
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Health Physicist
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Medical Director, Operations

Blue Shield Of California
Rancho Cordova, CA
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External Description Str : Your Role The Medical Director, Commercial is a ...
Details
Summary
About the job:
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 Medical Director of Medical Operations. Your Work In this role, you will: - Be the medical decision-maker and support for the prior authorization registered nurse (RN) team, facilitating appropriate...
Location:
Rancho Cordova, CA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Board Certified
Certified Registered Nurse
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Case Management - Nurse, Senior

Blue Shield Of California
El Dorado Hills, CA
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External Description Str : Your Role The Care Management team will serve to ...
Details
Summary
About the job:
support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting . The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and...
Location:
El Dorado Hills, CA
Job Type:
Part-Time
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Registered Nurse
Certified Case Manager
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Delegation Operations Nurse Auditor - LVN, Experienced

Blue Shield Of California
Long Beach, CA
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External Description Str : Your Role The Delegation Oversight Utilization ...
Details
Summary
About the job:
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-Experienced will report to the Manager of UMDO. In this role you will be assist in maintaining continuous quality improvement in the Utilization Management Delegation Oversight Clinical Audit ensuring that...
Location:
Long Beach, CA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Postsecondary nondegree award
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information
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Salary: Six Figures Jobs ($100K+)
Industry: Health Care and Social Assistance
Company Name: Blue Shield Of California
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