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Blue Shield of California jobs in Long Beach, CA

- 43 jobs
  • Sr. Director, Product Strategy, Lines of Business

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Sr. Director, Product Strategy, Lines of Business is critical to the success of Blue Shield of California and the Product and Customer Strategy department in realizing its goals and objectives. In this role, you will be responsible for leading, delivering, and collaborating on all aspects of health plan and benefit design and portfolio management across the Commercial, Medicare, Medi-Cal, Pharmacy and Specialty lines of business. This role will articulate Product strategies to support Line of Business performance goals from both a membership and financial perspective. The Sr. Director, Product Strategy, Lines of Business will report to the Vice President, Product and Customer Strategy. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience; master's degree preferred Requires at least 12 years of prior relevant experience, including 6 years of management experience with direct reports Requires at least 5 years of experience in healthcare consulting and/or strategic planning within the healthcare sector or managed care Proven track record of developing product vision, strategy, and roadmaps across multiple lines of business Demonstrated success in leading cross-functional teams such as product design, program delivery, marketing, and analytics strongly preferred Experienced in product lifecycle management, portfolio prioritization, and performance measurement strongly preferred Proficiency in leveraging customer research, data analytics, and competitive intelligence to inform strategy strongly preferred Skilled in developing go-to-market strategies, collateral, and sales enablement tools strongly preferred Ability to manage budgets, timelines, and resource allocation to ensure successful product launches strongly preferred #LI-AD3 Your Work In this role, you will: Work closely with VPs, SVPs and line of business leaders (GMs) on generating a winning Product Vision, Strategy and prioritized roadmap of health plan and benefit investments for the Commercial, Medicare, Medi-Cal, Pharmacy and Specialty lines of business Work with customer research, data analytics, and competitive intelligence teams to develop strong outside-in perspective and identify the biggest areas of individual and employer need and business opportunity across each lines of business Lead and mentor a highly specialized team of Product Directors and Managers that own the lifecycle of assigned health plan and benefit products for their lines of business. This includes developing product vision and strategy, as well as defining and measuring success and performance metrics for each portfolio of health plan and benefit products. Partner with the New Product team to influence development of new product solutions and capabilities and ensure all new capabilities are ready across each line of business Ensure all launches are delivered on time and on budget, which includes collaborating with the Health Plan Operations Product Cycle team managing the implementation of the portfolio lifecycle Work closely with the Product Marketing team to develop go-to-market plans, baseline collateral and sales training for new plans and benefits Build and manage a high performing team, including developing individual goals and objectives tied to business goals and executing on a people strategy that will maximize results and continue Blue Shield of California's priority to be a Great Place to Work
    $163k-212k yearly est. Auto-Apply 3d ago
  • Sr. Manager, Program and Project Management (Pharmacy Benefits Management)

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Pharmacy Production Stabilization team provides management and end-to-end oversight of all Pharmacy production stabilization issues, driving issues from identification to resolution within a matrixed environment. The Senior Manager of the Pharmacy Production Stabilization team will report to the Director of Pharmacy Performance. In this role you will be responsible for the management and ownership of the end-to-end activities needed to bring all pharmacy production stabilization issues to full resolution, develop executive level communications and reporting to keep key stakeholders informed of status, and support annual readiness activities. Leading a team of professionals, you will drive processes and business efficiencies in support of our culture of affordability. This position will work closely with the Pharmacy Strategy and Operations team, cross-functionally with other teams within Blue Shield, as well as with our external vendor partners to ensure timely and accurate resolution of pharmacy production stabilization issues. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 10 years of prior relevant experience, including 4 years of management experience Advanced knowledge of pharmacy operations at the health plan level Experience driving strategic projects and partnering cross-functionally as well as with external vendor partners to achieve successful outcomes Excellent verbal and written communication skills that exhibit a solution-oriented approach Excellent analytical and problem-solving skills Demonstrated leadership, project management, and program evaluation skills Your Work In this role, you will: Partner with business drivers to execute on sub portfolio delivery including schedule, scope, resource management, financials, benefit tracking, knowledge of emerging technologies and issue/risk management to ensure successful completion of all projects and programs in support of the business strategies Partner with managers to manage intake, Rough Order of Magnitude (ROM) estimation and demand/ capacity to ensure projects within the program meet cost, resource, environment, schedule, and other constraints within their domain Provide oversight and direction of all the projects and releases within the sub portfolio (schedule, issues/risks, budget, resources, and PPM/PWA adherence) Oversee and manage senior project managers, project managers and analysts in support of the delivery of the sub portfolio Be accountable for ensuring overall program and project delivery, schedule and budget attainment, and effective management of leadership expectations in achieving overall desired outcomes, results, and deliverables Provide direction, ownership, and oversight over the end-to-end Blue Shield production stabilization process, including Blue Shield and vendor specific incidents to assure that production stabilization issues that are partially or fully caused by contracted vendors and affiliated companies are resolved timely and accurately Manage intake, assignment, direction, and resolution on pharmacy production stabilization issues and solutions that affect the Blue Shield book of business, including collaboration with stakeholders at all levels, identification of downstream impacts to ensure that issues are fully remediated without unintended negative consequences and identifying production stabilization issue trends, operational improvement opportunities, and providing expert recommendations to stakeholders and vendors Assures that all production stabilization incidents have complete documentation from root cause analysis, impact reports, solution alternatives, decisions, communication plan, and implementation Oversee and manage activities related to supporting the Pharmacy Annual Readiness and Command Center (RxARCC) team. Oversee and manage activities related to maintaining the pharmacy business continuity plan including annual reviews and audits Other duties as assigned
    $133k-165k yearly est. Auto-Apply 4d ago
  • Hallmark Retail Sales Leader (part-time key holder) - Store #483 (Thousand Oaks, CA)

    Hallmark 4.4company rating

    Thousand Oaks, CA job

    HALLMARK - Because Connecting With Each Other Has Never Been More Important. This part-time opportunity is located at our Hallmark Corporate owned Gold Crown store #483 in The Oaks Mall located in Thousand Oaks, CA. You'll add value to one of the world's most iconic consumer brands and be part of our company with a life-affirming purpose to inspire meaningful connections. Through our products, content and experiences we aim to create a more emotionally connected world by making a genuine difference in every life, every day. Our business believes in the value of diversity and creates a culture of inclusion through every brand, product and person we touch. The Hallmark Gold Crown store is the destination for all things caring. The place where all the magical things Hallmark has to offer - cards, gifts, ornaments, movies, and more -- come to life to inspire and support people in their desire to care and connect. We help with the perfect solution for all of life's relationships and occasions - to feel more deeply, to celebrate more uniquely, and to connect more often. Our store team is driven to reach store goals while delivering a memorable experience to each of our shoppers because we genuinely care and choose to make a difference in the world and in our communities. Our Part-Time Sales Leaders are key to providing a ‘caring team' atmosphere for our customers. The difference begins with YOU! WHAT YOU WILL DO: Our Part-Time Sales Leaders bring the Hallmark mission to life in the store. They are the face of the Hallmark brand to customers and vital to the success of Hallmark. THE PART-TIME SALES LEADER DUTIES TO INCLUDE: Delivering an exceptional consumer shopping experience that leaves guests feeling inspired, ready to connect, and eager to return. Modeling and coaching service and selling skills while, helping customers find the perfect card and gift solutions. Leading store associates when the Store Manager is not available, providing feedback along the way. Communicating daily priorities, goals, and business information, while maintaining fun and supportive team environment. Executing store operations -- product replenishment & merchandising, ringing sales, processing shipments, managing inventory, point-of-sale audits, seamless retail, etc. YOUR AREAS OF KNOWLEDGE AND EXPERTISE: Basic Qualifications At least 18 years of age. One or more years of experience in retail, sales, or customer service; OR at least 6 months experience in a Hallmark Corporate Store. Ability to work a flexible schedule that meets the needs of the business, including, events, holidays, evenings, and weekends. Availability to open and close the store 3+ times per week and 2+ weekend shifts per month. Ability to continuously stand/walk; frequently push/pull; occasionally bend/stoop/crawl/reach above shoulders/kneel; climb a ladder, and carry up to 40 pounds, e.g., fixture parts and cartons. Preferred Qualifications High school diploma or equivalent. Two or more years of previous experience in (specialty) retail, sales, or customer service. Strong customer-focused engagement and consultative selling skills. Ability to communicate effectively with customers and employees. Proficiency and comfort using a computer and other technology. WHY YOU'LL LOVE WORKING AT HALLMARK: We want to help you be your best - at work and at home, now and in the future. It's why providing benefits to support you and your family's well-being is one of the most important investments Hallmark makes. Hallmark employees in our Gold Crown stores play a direct role in helping our consumers connect, celebrate, and commemorate life's special occasions. Take care of you and yours Savings/401(K) plan with 3% company match. Retail Sales Leads and Store Associates are part of the RSG Savings Plan which offers a 60% company match on employee contributions up to 5%. The employee is eligible after completing 1000 hours of service in first anniversary year or in any calendar year thereafter. Investment assistance. Part-time employees with a work schedule in WorkWell of less than 30 hours are not eligible for Hallmark's group health and welfare benefits. These employees have access to a variety of other voluntary benefits through Voluntary Benefits; including dental, vision, critical illness, accident insurance, hospital indemnity and minimum essential coverage (preventive care). And more! Like a 40% shopping discount on merchandise purchased in a CSG store. As well as a variety of local and national discounts made available by PerkSpot. The hourly pay range for this position is between $17.50 and $18.00. Now's your chance to embrace a future with Hallmark-just follow the instructions below to apply. You must show how you meet the basic qualifications in a resume or document you upload, or by completing the work experience and education application fields. Accepted file types are DOCX and PDF. In compliance with the Immigration Reform and Control Act of 1986, Hallmark Cards, Inc. and its subsidiary companies will hire only individuals lawfully authorized to work in the United States. Hallmark does not generally provide sponsorship for employment. Employment by Hallmark is contingent upon the signing of the Employment Agreement, signing of an agreement to arbitrate in connection with the Hallmark Dispute Resolution Program, completing Form I-9 Employment Eligibility Verification, passing the urinalysis drug screen, education verification and satisfactory reference and background checks. Hallmark is an equal opportunity employer. All qualified applicants will be considered for employment without regard to race, color, religion, sex, age, pregnancy, national origin, physical or mental disability, genetics, sexual orientation, gender identity, veteran status, or any other legally-protected status. Principals only please.
    $17.5-18 hourly 60d+ ago
  • Hallmark Field Merchandiser (part-time) - Long Beach, CA 90805

    Hallmark 4.4company rating

    Long Beach, CA job

    To learn more about this role, watch our field merchandisers in action. As a Field Merchandiser, you'll have the opportunity to work independently to showcase your organization and time management skills, your ability to establish retailer relationships, while being the face of Hallmark. You will collaborate with local store teams to optimize product placement and maintain inventory levels as well as support fellow team members with seasonal resets and installations, when needed. On occasion you may have the opportunity to work with other products from other companies in the stores that you service. SALARY AND SCHEDULE DETAILS * Your starting pay will be $17.87 to $18.00 depending on your skills and experience. * Eligible Employees receive annual pay increases. * This is a Part-Time position with a variable schedule during the work week. * Average weekly hours for this position are between 4-7 hours per week. * Availability the week before and after major holidays, which may include weekends is required. YOUR ROLE AND RESPONSIBILITIES WILL INCLUDE You'll perform service work in the Hallmark department of various retail stores such as grocery stores, drug stores, department stores, and mass retailers. The retail merchandiser position consists of three major components: * Day-to-day engagement: Utilizing a mobile device provided by Hallmark, you'll restock, organize, and monitor the inventory of Hallmark products within and outside the Hallmark department. The use of technology is critical in this role, for the day-to-day work as well as communication with your supervisor, reporting time, providing feedback, and answering surveys for required merchandising activities. Professional and courteous interaction with store employees, management, and customers is also vital for success in this role. You are responsible for the entire Hallmark product display at your assigned stores. * Holiday support: Hallmark's operations revolve around seasonal demand. Leading up to and following holidays such as Valentine's Day, Easter, Mother's Day, Father's Day, Halloween, Thanksgiving, and Christmas, you can expect additional days and extended hours during the work week. On occasions like Valentine's Day, Mother's Day, and Father's Day, you may be required to work on the actual holiday itself, which may include the weekend. * Department Resets: At times, you may be part of a team responsible for installations and various tasks like building and installing Hallmark fixtures, relocating card departments and products, as well as resetting card sections. Typically, you will be notified two weeks in advance for remodel assignments. This could include evenings or weekend. * One Team Vision: As part of Hallmark's field organization, you are part of a network of merchandisers professionals that often times will support other team members as needed in their territories. PHYSICAL REQUIREMENTS This is a physically demanding job that requires a high level of energy and a sense of urgency. You will be working on the selling floor as well as in back stockrooms. You must be able to consistently push, pull, lift, and carry cartons, merchandise, and display fixtures up to 30 pounds throughout the workday and up to 50 pounds on occasion. You will also be required to kneel, squat, walk, and stand throughout your workday, and you may be required to climb stairs and step ladders. BASIC QUALIFICATIONS * You're at least 18 years of age. * You're able to read, write and understand English. * You have the ability to grasp, pull, lift, and carry products up to 30 pounds frequently and 50 pounds occasionally. * Able to operate a digital hand-held device to open and read documents and interpret information. * You have access to a Wi-Fi network and the internet. * You have access to consistent transportation to travel to and between assigned stores as scheduled. Part-time employees with a work schedule less than 30 hours have access to a variety of voluntary benefits through Voluntary Benefits including dental, vision, critical illness, accident insurance, hospital indemnity and minimum essential coverage (preventive care). Prior to applying, watch our field merchandisers in action. Now's your chance to Make Your Mark-just follow the instructions below to apply. You must show how you meet the basic qualifications in a resume or document you upload, or by completing the work experience and education application fields. Accepted file types are DOCX and PDF. Part-time employees with a work schedule less than 30 hours have access to a variety of voluntary benefits through Voluntary Benefits including dental, vision, critical illness, accident insurance, hospital indemnity and minimum essential coverage (preventive care). In compliance with the Immigration Reform and Control Act of 1986, Hallmark Cards, Inc. and its subsidiary companies will hire only individuals lawfully authorized to work in the United States. Hallmark does not generally provide sponsorship for employment. Employment by Hallmark is contingent upon the signing of the Employment Agreement, signing of an agreement to arbitrate in connection with the Hallmark Dispute Resolution Program, completing Form I-9 Employment Eligibility Verification, and successfully pass pre-employment (post offer) background check. Hallmark is an equal opportunity employer. All qualified applicants will be considered for employment without regard to race, color, religion, sex, age, pregnancy, national origin, physical or mental disability, genetics, sexual orientation, gender identity, veteran status, or any other legally-protected status. Principals only please. HALLMARK - Because Connecting With Each Other Has Never Been More Important For over 100 years, Hallmark has helped people connect and strengthen the relationships that matter most. Today, we're building the next century of connection- blending the warmth of in-store experiences with the ease of digital innovation. We're looking for empathetic learners, strategic thinkers, and enthusiastic visionaries from all backgrounds to help shape what's next. If you're ready to bring fresh ideas and energy, we'd love to have you on the team! At Hallmark, you'll feel welcomed from day one- whether you're remote, hybrid, or in-office. We'll tap into your strengths, offer leadership opportunities, and support your growth every step of the way. Our culture is rooted in care and inclusion. We celebrate diverse perspectives and actively seek out new voices- like yours- to help us grow and evolve. Let's imagine the future of Hallmark together!
    $17.9-18 hourly 8d ago
  • Appeals and Grievances Representative, Intermediate (Medi-Cal)

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Blue Shield Promise Medi-Cal Appeals and Grievance team researches and resolves member/subscriber grievances, appeals, and interprets and explains health plan benefits, policies, and procedures to Medi-Cal enrollees. The Medi-Cal Appeals and Grievance Coordinator will report to the Operations Supervisor. In this role you will be responsible for producing complex written correspondence within timeliness compliance, resolving member grievances and appeals specific to mandates, and meeting Regulatory timeframes . Your Knowledge and Experience Requires a high school diploma or GED Requires at least 2 years in health insurance operations such as I&M, Claims, Customer Services, Regulatory Affairs and/or Appeals/Grievances or similar combination General knowledge of applicable legislation/regulations and compliance . Demonstrated proficiency with free format letter writing . Experience with Microsoft Office applications required . Your Work In this role, you will: Assist with telephone inquiries regarding member appeals. Respond to appeals in grievances and member reconsiderations. Research, review, and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process Interpret and explain health plan benefits, policies, procedures, and functions to members and providers. Administer ongoing grievance tracking, trending, and reporting for assigned grievances. Must be willing to work unplanned overtime or Saturdays as inventory demands may increase.
    $38k-45k yearly est. Auto-Apply 3d ago
  • Risk Adjustment Consulting, Senior

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer centric. The Risk Adjustment Consulting, Senior will report to the Senior Manager of Risk Adjustment. In this role you will provides essential support to the Prospective Programs (In-Home Visit) within the Risk Adjustment Prospective Program (aka ProsPr) team. This includes interaction within the Risk Adjustment team, with various cross-functional teams within Blue Shield, Blue Shield IPA/MG and working directly with our vendors supporting our prospective programs. The ideal candidate possesses excellent interpersonal skills, project management skills, organizational skills, has high attention to detail, and is self-motivated. The candidate will also possess a desire to continually learn. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 3 years of professional experience Requires proficiency in Excel, Word, PowerPoint, and Outlook Requires previous project/program management experience Vendor management or Provider-facing experience desired Requires strong communication and presentation skills Your Work In this role, you will: Analyze information for core principles and functionality of decision, descriptive and predictive analytic methods including forecasting, statistical and machine learning techniques Train lower-level analysts on how to update and apply these advanced analytic techniques Contribute to successful programs for the team, engaged multiple areas related to vendor oversight, internal cross-functional partnerships, tracking performance and measuring results Lead data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products Facilitates the In-Home Visit (IHV) program from start to finish. Works with internal and external teams on all aspects of the IHV program and monitors vendor performance to ensure alignment Gathers and communicates information clearly in both in-person and virtual meetings Manages projects and timelines to achieve positive results Be able to provide backup support when asked
    $91k-115k yearly est. Auto-Apply 7d ago
  • Pharmacist, Principal

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations and Blue Shield. The RxMAPS team drives analytic strategy and performs clinical and business analyses necessary to provide consultations and strategic program recommendations to improve Cost of Health Care (COHC) and optimize outcomes. The Principal Pharmacist, Cost of Health Care will report to the Senior Manager, Rx Data Information Oversight and Reporting. In this role you will play a key role in leading and collaborating cross-functionally with key stakeholders across Blue Shield to drive analytic strategies and perform clinical and business analyses to improve COHC and optimize outcomes. You will monitor pharmacy and medical drug trends and the drug pipeline, and work with Actuarial and Finance teams to explain drivers of trend and identify opportunities for trend management. You will work with Enterprise Analytics to track and forecast COHC savings from pharmacy initiatives. Your Knowledge and Experience Requires a Doctor of Pharmacy (PharmD) degree Requires a currently active and unrestricted California Registered Pharmacist (RPh) license Requires at least 4 years of experience in clinical pharmacy Requires at least 3 years of experience in pharmacy benefit management and managed care health plan working with large pharmacy and medical claims datasets Experience with other pharmacy data (e.g., pharmacy and medical rebates, pharmacy networks, prior authorization) is preferred Requires proficient data analytic skills with Microsoft Office (e.g., Excel and Access) and other data analytic tools (e.g., SQL, SAS, Snowflake, Tableau) Requires ability to leverage business and clinical knowledge to interpret health plan benefit utilization and pharmacy financial data and derive actionable recommendations for COHC savings initiatives Requires understanding of pharmacy data parameters available for analysis Requires ability to work independently with minimal oversight and direction from the manager Requires ability to work collaboratively with multi-disciplinary and cross functional teams Requires excellent presentation, verbal, and written skills with ability to understand and convey complex ideas to an audience with diverse backgrounds Requires the ability to work in a fast-paced environment with a "can do" attitude and solution-oriented approach to resolve challenges Your Work In this role, you will: Analyze and monitor prescription drug claims, medical drug claims, and program data to identify opportunities to improve quality and cost of healthcare Serve as a BSC Pharmacy Strategy and Operations contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work Proactively monitor pharmacy trends (e.g., brand and generic drug pipeline, new legislation and regulatory requirements, COHC initiatives) Provide pharmacy trend driver variance explanation (e.g., utilization, drug mix, unit cost) Present findings on drug pipeline, COHC initiative savings, and other drivers of trend to help drive COHC initiative ideation and strategy with cross-functional stakeholders Support Enterprise Analytics in developing COHC savings methodology and reporting to estimate, track, and forecast COHC initiative savings Work with Actuarial teams to enable accurate pharmacy pricing and trend forecast for quarterly Trendsetter processes Participate in lines of business finance and performance review meetings to understand and/or provide input on business drivers and objectives Work cross-functionally to support and drive on-time submission of select state and federally mandated reports Respond to trend surveys, request for proposals, and other data analytic requests
    $150k-185k yearly est. Auto-Apply 44d ago
  • Program Manager, Consultant (Pharmacy Benefits Management)

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Pharmacy Production Stabilization team provides management and end-to-end oversight of all Pharmacy production stabilization issues, driving issues from identification to resolution within a matrixed environment. The Program Manager, Consultant will report to the Sr. Manager, Pharmacy Production Stabilization. In this role you will lead intake and initial assessment of new pharmacy issues, partner with subject matter experts to perform root cause analysis, identify impacts and potential solution options, develop and drive the summary and action plan including any remediation needed for medium to large issues impacting Pharmacy Strategy and Operations. Working in a matrixed environment, the Program Manager, Consultant will partner with cross-functional teams and external vendor partners to ensure alignment with stakeholders. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 7 years of prior relevant experience Advanced knowledge of pharmacy operations at the health plan level Excellent analytical and problem-solving skills Excellent interpersonal, verbal and written communication skills that exhibit a solutions-oriented approach Demonstrated leadership, project management, and executive level reporting experience Experience using MS Office tools including Excel, PowerPoint, and Project Experience building SharePoint sites to enhance team functionality Your Work In this role, you will: Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation Develop resourcing strategies to ensure optimum support for projects and for the day-to-day operational activities Review program budget variance and scope change requests, and participate in the budget-resolution process Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives Lead intake efforts, own and perform initial assessment of new medium to large pharmacy production stabilization issues Working with stakeholders, subject matter experts, and management both within and outside the pharmacy department, you will own and drive the end-to-end efforts associated with resolving the medium to large pharmacy production stabilization issues assigned to you Develop a summary and action plan including root cause analysis, solution options, remediation efforts, and a timeline for resolution of each pharmacy issue Develop and drive a detailed resolution plan for highly matrixed and complex pharmacy production stabilization issues Develop and distribute executive summary reports to keep leadership and other key stakeholders informed of status and progress Other duties as assigned
    $136k-179k yearly est. Auto-Apply 4d ago
  • Clinical Quality Auditor, Consultant (RN)

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Clinical Quality Auditors also provide coaching and work closely with business leaders to drive optimal results. The Clinical Quality Auditor, Consultant will report to the Quality Review Senior Manager. In this role you will develop performance metrics, evaluate performance, and provide coaching to ensure that staff have the skills and knowledge required to be successful in Population Health Management and Utilization Management. Your Knowledge and Experience Requires a Bachelor's of Science in Nursing or advanced degree preferred Current California RN license required At least 7 years of experience in managed care or similar complex healthcare environment with a minimum of 1 year experience in Case Management required Auditing experience preferred Population Health Management and Utilization Management experience preferred Strong organizational and/or project management skills to coordinate departmental projects and to perform multiple projects or tasks simultaneously Subject matter expert with capability to effectively audit and train all lines of business (Commercial, Federal Employee Program, Medicare, and Medi-Cal) Your Work In this role, you will: Perform audits for Population Health Management (PHM) and Care Coordination adhering to monthly productivity and quality metrics. Review audit data to identify care gaps, compliance risks, and trends. Communicate findings to leadership and provide recommendations to mitigate risks. Design, implement, evaluate and improve audit criteria and coaching strategies to meet the needs of PHM clinical staff. Provide developmental coaching and support to all staff to improve the skills and competencies required to successfully perform work. Conduct effective presentations relating to PHM processes and/or regulatory compliance for clinical staff. May independently represent the Quality Review department in PHM and work re-design, process changes and software implementation. Act as a resource for the training and auditing team
    $77k-100k yearly est. Auto-Apply 11d ago
  • Appeals and Grievances Representative, Advanced- CalPERS

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    Your Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints for our Commercial line of business. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to incoming appeals and grievances within established compliance timeframes. Your Knowledge and Experience Requires a high school diploma or GED Requires at least 4 years combined operations experience such as I&B, Claims, Customer Services, Regulatory Affairs; of which at least 1 year of direct experience is in Appeals/Grievances, or similar combination Requires knowledge of Microsoft Systems such as Power Point, Excel, and Word Commercial appeals and grievances knowledge or experience preferred Note: You may be placed in a specialty client, or other unit, such as CalPERs. Your Work In this role, you will: Answer telephone inquiries regarding member appeals. Respond to appeals and grievances and member reconsiderations. Research, review and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process. Interpret and explain health plan benefits, policies, procedures and functions to members and providers. Prepare files for clinician review. Provide guidance to and act as authoritative source for others within same skill set. Administer ongoing grievance tracking, trending, and reporting for assigned grievances. Review incoming appeals and grievances and determine which area to assign case to or reroute if the issue does not meet appeal or grievance criteria. Work in a collaborative manner with your team to meet compliance timeframes. Manage your time independently to ensure that all job duties are completed in a timely manner.
    $61k-88k yearly est. Auto-Apply 3d ago
  • Clinical Coding Analyst, Experienced

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    Your Role As a Clinical Coding Analyst-Experienced, specializing in code governance, you will play a pivotal role in ensuring coding standards, compliance, and best practices across development teams. Your responsibilities will include implementing and maintaining a code governance framework, conducting code reviews, optimizing development workflows, and ensuring adherence to industry standards. You will collaborate with cross-functional teams to establish coding guidelines, automate governance processes, and enhance overall software quality and security. Your expertise will drive efficiency, consistency, and compliance in coding practices, supporting scalable and maintainable solutions. Your Knowledge and Experience Requires a minimum of an AA degree; Bachelors' degree preferred AHIMA Certified CCS Preferred certification as CSS-P Possess deep technical abilities Work history in one of more of the following: 2 to 3 years of Provider billing experience in a lead, supervisory or management role; or 1 to 2 years in a payor environment working directly with payment quality and accuracy in a claims processing, providing contracting or audit capacity or; 1 to 2 years in a compliance or audit function within a health care system Requires broad theoretical job knowledge typically obtained through advanced education Intermittent proficiency in Microsoft Excel, Word and Powerpoint Your Work In this role, you will: Provide expert input to quarterly and annual industry standard code maintenance for multiple systems Research and prepare benefit files using industry standard codes that meet the intent of member benefit language and/or contracts, and regulatory mandates set forth by the state or federal agencies Develop payment policies based on industry or content expert-supported research Provide problem management recommendations on correct application of payment and benefits based on industry and internal research Conduct research and provide recommendations on industry standard editing for appropriate application in the current system in accordance with Blue Shield of CA payment policies and regulatory guidelines Collaborate with cross-functional departments to implement code governance framework
    $93k-115k yearly est. Auto-Apply 8d ago
  • 2026 Winter/Spring Value-Based Platform Internship

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    Your Role The Value-Based Platform team oversees and executes operations and implementations for the Pay for Value program. The program is housed under Network Strategy & Provider Partnerships and involves applying value-based payment models to care delivery with the goal of lowering health care costs while improving outcomes via the use of incentives tied to performance within the model. The value-based platform intern will report to the Senior Manager on the Value-Based Platform team. In this role, they will support a variety of tasks related to operations, such as report delivery, quality assurance and payment processing. Your Knowledge and Experience Actively pursuing a bachelor's or master's degree in public health, business, health care or related field Must reside in the state of California for the duration of the internship Minimum 1 year of related professional experience, project, or coursework Strong communication skills required, particularly writing for publication Proactive, solution focused mindset with demonstrated creative, problem-solving skills Knowledge of the key synergies necessary among practices, payers, community, populations, and policy leaders to better align health care transformation efforts Passionate about changing healthcare and challenging the status quo to advance health equity Proficient in Microsoft applications, including Outlook, Word, Excell, and SharePoint Pay $25.00 per hour for Undergraduate $30.00 per hour for Graduate About Our Internships Our paid internship program is thoughtfully curated to provide students experience and exposure to the health professional industry. Interns will be given the opportunity to get hands-on experience with real work projects, build meaningful relationship and connections within the organization, and experience our mission and enterprise goals through our program curriculum centered on our leadership model (Personal, People, Thought, and Results Leadership). To see more about our internship program, check out this video. Our Winter/Spring 2026 Internship is January 26th through May 15th, 2026. Application Process and Timeline: Now: Actively accepting applications December If you meet the requirements, you will receive an invitation to complete Pre-Recorded Video Interview December - January: 2nd round interviews & offers extended As an intern at Blue Shield of California, you will: Participate in impactful projects during a 16-week internship program Undertake a 16-week internship at 20 hours per week, curriculum designed to familiarize interns with BSC, leadership development, exposure to the healthcare industry, and more Be invited to participate in BSC employee events and networking opportunities such as Employee Resource Groups, employee volunteer activities, and more Your Work In this role, you will: Below is some information on the project this intern will be working on: Performing validation of Payment Model reports and posting them to provider connection or SharePoint Performing validation of Payment Model payment file and sending to Non-Claims Payment Manage the Payment Model Operations logs, work with business teams to document new items or provide updates. Work with technical teams to obtain updates of items Manage / triage the provider facing email boxes and track all items in our tracking spreadsheet
    $25-30 hourly Auto-Apply 7d ago
  • Clinical Services Coordinator, Intermediate

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    Your Role The Care Management Department is seeking a dedicated and compassionate Clinical Service Coordinator (CSC) to join our team. The Clinical Service Coordinator will report to the Supervisor of Care Operations. The CSC will play a vital role in outreach and engagement efforts with our members, introducing them to care management services, and conducting assessments to identify their needs. The successful candidate will interact telephonically with members to assist with simple care coordination needs and facilitate connections between members and appropriate services, including internal nurse care managers, vendors, and behavioral health providers. Your Knowledge and Experience A minimum of a high school diploma or equivalent required A minimum of 3 years of relevant experience is required A minimum of 1 year experience in a managed care environment preferred Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal) preferred Community resources and advocacy experience preferred Ability to identify issues and develop effective solutions to meet members' needs Flexibility to adjust to changing circumstances and member needs Strong verbal and written communication skills to effectively convey information to members and colleagues Ability to work an 8 hour shift between the hours of 8 am to 7 pm PST. Ability to work Saturdays once per quarter. Your Work In this role, you will: Conduct telephonic outreach efforts to engage members and introduce them to care management services. Complete thorough assessments to identify member needs and care gaps Maintain accurate and up-to-date member records and documentation of all interactions and services provided Conduct follow-up calls to ensure members' needs are being met Provide members with information and resources about available care management services and how to access them Provides administrative/clerical support to medical and disease management programs. Acts as a liaison, gathers information, and track all patients referred to the care management programs. Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc. Assists in verifying health plan benefits and coordinating ambulatory services. Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client's cultural context. Assists with precepting responsibilities for new hires and auditing efforts.
    $59k-77k yearly est. Auto-Apply 4d ago
  • Program Manager Clinical, Principal

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Long Beach, CA

    Your Role The Clinical Program Manager, Principal in collaboration with the Regional Medical Director and the CMO Team for Commercial Business will be responsible for collaborating with all internal stakeholders and externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction) with a focus on execution to drive and accelerate improvements in primary care for all patients. This role will report to the Regional Medical Director. Your Knowledge and Experience Requires a current, active California RN, NP, or PA license Requires a bachelor's degree; advanced degree is preferred Requires a minimum of 10 years of prior relevant clinical or job related experience Requires previous health plan experience with understanding of Accountable Care Organizations (ACO), global versus shared risk financial arrangements, quality metrics and member experience. Experience in case utilization and utilization management and managed care delegated models is a plus. In-depth understanding of data analytics with mastery of excel and an ability to use multiple data platforms for internal and external communication. Strong PowerPoint application skills to create executive summaries and presentation decks. Excellent verbal and written communication style to drive positive outcomes Ability to be resourceful and collaborative; a team collaborator with strong listening skills and the ability to offer creative solutions to drive consensus. Your work: In this role, you will: Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California's strategic goals Consult with all levels (including senior management) making recommendations and influencing decision-making Leverage cross-functional internal and external relationships to drive initiatives forward Plan and implement multiple and extremely complex projects/programs spanning across business areas Determine key business issues, develop effective action plans, and implement to successful conclusion Perform data analysis for all lines of business: Analyze data in collaboration with Regional Medical Director for trends, drivers, and key initiatives. Incorporate the analysis into meaningful discussions with Group/IPA Identify opportunities around utilization, quality, and clinical initiatives: Work side by side with internal and external partners in the design and launch of clinical programs focused on high-risk members, hospital initiatives, and behavioral health as well as internal innovation programs Partner with medical groups to co-create programs encompassing a full spectrum of initiatives around disease management, complex care management, transitions of care and site of service, ensuring optimal utilization, access, and quality of care for members Lead with a collaborative approach and an understanding of existing resources and relationships between/among partner organizations while moving them towards constructive change Work cross functionally with Blue Shield of California internal teams to provide support both ad hoc and for recurrent initiatives
    $120k-144k yearly est. Auto-Apply 56d ago
  • Application Developer, Consultant

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    The IT Health Solutions Health Data Strategy team is responsible for delivering various initiatives including the Digital Health Record and health data exchanges with vendor partners. The Full Stack Engineer will report to the IT Applications Sr. Manager over Health Data Strategy. In this role you will be deeply involved in the design, development, and deployment of secure, high-quality software solutions. Your role will focus on integrating security and automation throughout the software development lifecycle (SDLC), with an emphasis on writing clean, maintainable code and building infrastructure that supports CI/CD pipelines, automated testing, and cloud-native delivery. You'll implement and enforce DevSecOps best practices tailored for Azure, contribute to infrastructure as code, and work closely with developers, testers, and cloud engineers to ensure code is secure, scalable, and production-ready from day one. This role requires a hands-on engineer who thrives in a collaborative environment and is passionate about code quality, automation, and secure cloud development. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Requires a bachelor's degree or equivalent experience Requires at least 7 years of prior relevant experience Must have Epic Payor experience and understands Clarity and Caboodle UI: React and/or Vue and experience with JavaScript, along with CSS responsive design practices Backend: .NET (2.0+), Python and Java, hosted across Windows and Linux environments. DB: SQL/PL-SQL - API integration tools and API testing tools such as Postman, Insomnia. CI/CD: Set up, build & execute continuous build & integration pipelines using BitBucket Pipelines or GitHub Actions Containerization: Build a containerized code using Docker & deploying, maintaining containerized code deployment on a container orchestration environment like AKS, RHCP Experienced with infrastructure as Code tools like Ansible & Terraform to provision and configure Cloud resources Familiarity with Networking set up in azure cloud and security protocols including TCP/IP, HTTP, SSL, DNS, LDAP, Active Directory, authentication protocols, SSH, and SFTP. Authorization/Authentication using OpenID Connect (OIDC) & OAuth2.0, Token based etc. Agile methodologies Ability to collaborate with stakeholders, vendors, and cross-functional teams Excellent verbal and written communication skills Be curious, make mistakes, leverage AI as smartly as one can and be proactive, take ownership of end to end technical delivery Be great team player. #LI-JA1 In this role, you will: Lead a team from start to finish which includes the following: Spearhead technical collaboration with vendor teams to define and document API structures, including data models, endpoints, and protocols Ensure both internal and external teams are aligned on API specifications, security standards, and integration workflows to enable a successful and seamless API handshake. Strong working experience in either Java, Python or .Net. Strong expertise in API design (REST, JSON, OAuth), cross-functional communication, and a proactive approach to resolving technical dependencies Create and maintain solution design artifacts for Azure cloud implementations using Lucidchart
    $132k-163k yearly est. Auto-Apply 44d ago
  • Operations Specialist, Experienced

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    Your Role The Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC) which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities. This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities. Reporting to the Manager, Delegation Oversight, this role is responsible for documentation of policies and procedures, and oversight of LA Care audits and quality review along with submission of data to compliance. The Operations Specialist, Experienced, is also responsible for working with colleagues on coordination and submission of state reporting to the Department of Managed Health Care (DMHC). This position is responsible for tracking and monitoring monthly, quarterly, and annual reporting timeliness and Provider Dispute Resolution to provide into the DMHC portal reporting. The Operations Specialist, Experienced position also reviews and provides to the DMHC Corrective Action Plans (CAPs) and requests for information. Your Knowledge and Experience Requires a college degree or equivalent experience Requires 3 years of prior relevant experience Experience working in or with IPA/Medical Groups is preferred Strong verbal and written communication skills Strong knowledge of Microsoft Office products Strong organizational and attention to detail skills Your work: In this role, you will: Act as a subject matter expert (SME) to review operational workflows of high degree of complexity and/or for multiple departments, identifying problems and developing improvements, modifications, and enhancements Develop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff Develop and generate reports ranging from routine to moderately complex for management review Track and communicate workflow and system changes to appropriate resources Participate as a SME in the development of written guidelines and documents problems Assist with documentation needs Maintain and update trackers required for business operations Perform other duties as assigned
    $38k-50k yearly est. Auto-Apply 60d+ ago
  • Retail Merchandiser (part-time) - Panorama City, CA 91402

    Hallmark 4.4company rating

    Los Angeles, CA job

    To learn more about this role, watch our retail merchandisers in action. As a Retail Merchandiser, you'll have the opportunity to work independently to showcase your organization and time management skills, your ability to establish retailer relationships, while being the face of Hallmark. You will collaborate with local store teams to optimize product placement and maintain inventory levels as well as support fellow team members with seasonal resets and installations, when needed. On occasion you may have the opportunity to work with other products from other companies in the stores that you service. SALARY AND SCHEDULE DETAILS * Your starting pay will be $17.87- $18.00 depending on your skills and experience. * This is a Part-Time position with a variable schedule during the work week. * Weekly hours for this position are between 4-6 hours per week. * Availability the week before and after major holidays, which may include weekends is required. YOUR ROLE AND RESPONSIBILITIES WILL INCLUDE You'll perform service work in the Hallmark department of various retail stores such as grocery stores, drug stores, department stores, and mass retailers. The retail merchandiser position consists of three major components: * Day-to-day engagement: Utilizing a mobile device provided by Hallmark, you'll restock, organize, and monitor the inventory of Hallmark products within and outside the Hallmark department. The use of technology is critical in this role, for the day-to-day work as well as communication with your supervisor, reporting time, providing feedback, and answering surveys for required merchandising activities. Professional and courteous interaction with store employees, management, and customers is also vital for success in this role. You are responsible for the entire Hallmark product display at your assigned stores. * Holiday support: Hallmark's operations revolve around seasonal demand. Leading up to and following holidays such as Valentine's Day, Easter, Mother's Day, Father's Day, Halloween, Thanksgiving, and Christmas, you can expect additional days and extended hours during the work week. On occasions like Valentine's Day, Mother's Day, and Father's Day, you may be required to work on the actual holiday itself, which may include the weekend. * Department Resets: At times, you may be part of a team responsible for installations and various tasks like building and installing Hallmark fixtures, relocating card departments and products, as well as resetting card sections. Typically, you will be notified two weeks in advance for remodel assignments. This could include evenings or weekend. * One Team Vision: As part of Hallmark's field organization, you are part of a network of merchandisers professionals that often times will support other team members as needed in their territories. PHYSICAL REQUIREMENTS This is a physically demanding job that requires a high level of energy and a sense of urgency. You will be working on the selling floor as well as in back stockrooms. You must be able to consistently push, pull, lift, and carry cartons, merchandise, and display fixtures up to 30 pounds throughout the workday and up to 50 pounds on occasion. You will also be required to kneel, squat, walk, and stand throughout your workday, and you may be required to climb stairs and step ladders. BASIC QUALIFICATIONS * You're at least 18 years of age. * You're able to read, write and understand English. * You have the ability to grasp, pull, lift, and carry products up to 30 pounds frequently and 50 pounds occasionally. * Able to operate a digital hand-held device to open and read documents and interpret information. * You have access to a Wi-Fi network and the internet. * You have access to consistent transportation to travel to and between assigned stores as scheduled. Part-time employees with a work schedule less than 30 hours have access to a variety of voluntary benefits through Voluntary Benefits including dental, vision, critical illness, accident insurance, hospital indemnity and minimum essential coverage (preventive care). Prior to applying, watch our retail merchandisers in action. Now's your chance to Make Your Mark-just follow the instructions below to apply. You must show how you meet the basic qualifications in a resume or document you upload, or by completing the work experience and education application fields. Accepted file types are DOCX and PDF. Part-time employees with a work schedule less than 30 hours have access to a variety of voluntary benefits through Voluntary Benefits including dental, vision, critical illness, accident insurance, hospital indemnity and minimum essential coverage (preventive care). In compliance with the Immigration Reform and Control Act of 1986, Hallmark Cards, Inc. and its subsidiary companies will hire only individuals lawfully authorized to work in the United States. Hallmark does not generally provide sponsorship for employment. Employment by Hallmark is contingent upon the signing of the Employment Agreement, signing of an agreement to arbitrate in connection with the Hallmark Dispute Resolution Program, completing Form I-9 Employment Eligibility Verification, and successfully pass pre-employment (post offer) background check. Hallmark is an equal opportunity employer. All qualified applicants will be considered for employment without regard to race, color, religion, sex, age, pregnancy, national origin, physical or mental disability, genetics, sexual orientation, gender identity, veteran status, or any other legally-protected status. Principals only please. HALLMARK - Because Connecting With Each Other Has Never Been More Important For more than a century, Hallmark has been bringing people together and improving the relationships that matter most. That's why millions of people all over the world connect with the Hallmark brand. It has always been a mission so much bigger than any one of us who work here. Today, we need empathetic learners, strategic thinkers, and enthusiastic visionaries with diverse experiences and skills to help us create the rest of Hallmark's second century as we shift to a more digitally savvy, unified approach that combines the best of brick-and-mortar retail with the efficiency of dot-com spaces. Help us imagine what our next hundred years could look like! When you join Hallmark, we will go out of our way to make you feel like part of the team. In the day-to-day, we'll make the best use of the skills and talents you already have. We'll also give you leadership opportunities and show you multiple potential pathways to future success. Our culture of care for our consumers and for one another shows in the way we embrace different backgrounds, identities, and working styles, deliberately seeking out ways to be more inclusive both internally among our work groups and externally through the things we make and sell to our retail partners and consumers. We believe that a broadly inclusive, equitable approach is also our best path to future success. We're seeking out those who can bring a fresh perspective to our business and would love your input as someone new to our team! We can only change and grow when we intentionally include new perspectives-like yours.
    $17.9-18 hourly 52d ago
  • Program Manager, Senior

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    Your Role The Quality Improvement Team is accountable for quality ratings and the organization, development, and execution of targeted, quality improvement initiatives in support of commercial medical groups, hospitals, affiliated providers, and our Covered California and CalPERS membership. The Program Manager, Senior will report to the Senior Manager, Quality Improvement. In this role you will be responsible in the commercial line of business for the development and execution of targeted, quality improvement initiatives with our external provider group partners to achieve improved outcomes in HEDIS measures. You will partner with other lines of business and align quality interventions to the organizational strategies for HEDIS, QRS, CAHPS, and our Covered California and CalPERS membership. The Program Manager, Senior will build relationships internally and externally, and manage data driven outcomes and targets, helping to facilitate getting provider data into our Blue Shield systems. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 5 years of prior relevant experience Knowledge of HEDIS and CAHPS required Requires previous experience in quality improvement and process/performance improvement, ideally in an outpatient healthcare setting Requires previous project/program management experience Requires solid facilitation skills with demonstrated excellence in driving multi-disciplinary and cross-functional teams to consensus Highly adept computer skills: demonstrated mastery of all MS Office products (including Outlook, Excel, PowerPoint, Word); ability to execute data analysis in Excel to drive root cause analysis and produce PowerPoint presentation deliverables Your Work In this role, you will: Direct small-scale, complex programs/projects that may involve multiple internal and external stakeholders Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products Develop the program, integrated program plan, resource plan, contingency plan, and related project management artifacts Validate financial forecasts and provide on-going reconciliation of resources and other related program expenditures Define and track program milestones while developing, maintaining, and reporting on an overall integrated delivery plan Be responsible for planning, execution, and evaluation of large and complex program initiatives to improve quality performance in the commercial line of business Educate and work with internal and external partners as needed to identify innovative quality improvement opportunities and adopt improvement actions Demonstrate thought leadership, critical thinking, excellent project management skills, knowledge and experience with program evaluation and consulting skills Perform other duties as assigned by management Manage a portfolio of provider groups and be accountable for key quality measure improvements through building strong partner relationships and data channels into Blue Shield's data systems
    $123k-157k yearly est. Auto-Apply 60d+ ago
  • Application Developer, Senior

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    This role will align to the Quality team within the Care Management & Quality Platform that designs and solutions accountable for secure, compliant and high-quality software delivery. The Full Stack Engineer will report to the Senior Manager of the Quality Team. In this role you will be involved in the hands-on design, development and deployment of secure, high-quality software solutions. Your role will focus on integrating security and automation throughout the software development lifecycle (SDLC), with an emphasis on writing clean, maintainable code and building infrastructure that supports CI/CD pipelines, automated testing and cloud-native delivery. You will implement and help to ensure DevSecOps best practices tailored for Azure, contribute to infrastructure as code and work closely with developers, testers and cloud engineers to ensure code is secure, scalable and production-ready from day one. This role requires a hands-on engineer who thrive in a collaborative environment and is passionate about code quality, automation and secure cloud development. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Bachelor's degree in computer science, Information Technology, Management Information Systems, or a related field (or equivalent experience), with a minimum of 5 years of relevant experience in enterprise application support and cloud-based solution delivery. Proven hands-on experience in the design, coding, integration, and deployment of applications on Microsoft Windows and/or Linux Server platforms, including strong knowledge of N & N-1 operating systems, Remote Desktop Services, and server technologies. Skilled in modern front-end frameworks such as React and/or Vue, with proven experience in component-based architecture and state management (e.g., Redux, Pinia). Solid experience with JavaScript, along with CSS responsive design practices Skilled and experienced with scripting and automation skills using tools such as PowerShell, ANT, Jython, Python, InstallShield, and SCCM, with experience in automating builds, deployments, and configurations. Knowledge in API design (REST, JSON, OAuth) Skilled and experienced in supporting applications built on COM+, DCOM, .NET (2.0+), and Java, hosted across Windows and Linux environments. Familiarity with networking and security protocols including TCP/IP, HTTP, SSL, DNS, LDAP, Active Directory, XML, IIS, authentication protocols, SSH, and SFTP. Skilled and experienced with SQL/PL-SQL knowledge and experience with API integrations using Java and other tools. Skilled and Experienced in Unix command-line operations, including directory navigation, file manipulation, and shell scripting, along with utilities like awk, sed, and Perl. Hands-on experience with CI/CD pipelines (e.g. Bitbucket Pipelines, GitHub Actions) and Infrastructure as Code tools like Ansible to automate cloud deployments. Working knowledge of deploying and managing applications using containerization (Docker) in cloud environments like Azure, AWS, or GCP. Familiarity with Agile methodologies, service-oriented architecture, and enterprise cloud integration, preferably with experience in Microsoft Azure and virtualization platforms such as Citrix. Demonstrated ability to collaborate with stakeholders, vendors, and cross-functional teams, with excellent verbal and written communication skills to translate and execute technical deliverable Preferred experience in the healthcare industry and working knowledge of Epic software. Strong process orientation with the ability to follow and improve procedures for critical maintenance and operational tasks. #LI-JA1 In this role, you will: Adopt and apply software engineering concepts and processes to software development Provide input to designs and technical specifications Develop user interfaces and application programs using the technical specifications and design documents provided Tests, debugs, and maintains code according to the technical specifications Provide knowledge transfer to less experienced staff Design and develop user interfaces and application programs using technical specifications and design documents, with a focus on cloud-native solutions and modern frameworks. Develop the most efficient and cost-effective implementation, leveraging reusable features where possible Support operational excellence, including but not limited to Incident Management, process automation leveraging AI, and ensuring smooth deployments for your technology products/platform features. Collaborate and implement improvements to departmental processes to enhance agility and efficiency. Enhance the reliability, scalability, and utilization of systems and applications through continuous integration and continuous deployment (CI/CD) practices. Monitor and manage software configuration changes to anticipate and address data reliability and customer satisfaction issues, leveraging cloud monitoring tools and practices. Contribute to sustaining support for multiple application platforms or business processes, ensuring seamless integration and operation in a cloud environment. Work with management direction and collaborate with team in determining the technical objectives of the assignment. Apply knowledge of IT and healthcare industry trends as required.
    $117k-143k yearly est. Auto-Apply 3d ago
  • Provider Contracting Specialist, Consultant

    Blue Shield of California 4.7company rating

    Blue Shield of California job in Los Angeles, CA

    Your Role The Provider Contracting team is responsible for contract negotiations, coordination, and ongoing support and interpretation of contracts for both internal and external partners. The Provider Contracting Specialist, Consultant will be responsible for negotiating provider agreements and accountable care collaboration agreements with medical groups/IPAs, hospitals, ambulatory surgery centers, and drive strategic initiatives to support Blue Shield of California's objectives to achieve growth and maintain strong market position and positive reputation in the market. Your Knowledge and Experience Requires a bachelors degree in business, healthcare policy, public health or related field, or equivalent experience Requires at least 7 years provider contracting/negotiation experience including experience managing complex negotiations Broad heath care industry knowledge with substantial experience negotiating and managing complex, high-profile provider contracts Excellent oral and written communication skills Advanced knowledge and skills including technical or functional expertise, business acumen, financial analysis, risk management, delegation, critical thinking, and decision-making Your Work In this role, you will: Negotiate all product (commercial, Medicare and Medi-Cal) complex provider agreements with medical groups/IPAs, hospitals, freestanding ambulatory surgery centers and accountable care collaboration agreements. Participate in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region Collaborate closely with Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals Drive alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.) Assess market trends and competitive benchmarks to enhance company's market position Conduct extensive investigation and apply critical thinking to understand root functions and/or businesses to develop new perspectives and innovative approaches on existing or new problems Communicate with external customers and vendors on new concepts, practices, and approach Responsible for managing large, complex project initiatives of strategic importance to the organization, involving cross-functional teams Frequently responsible for providing guidance, coaching, and training to other employees across the company within area of expertise Requires ability to communicate with executive leadership regarding matters of significant important to the organization, including writing comprehensive executive summaries May direct the work of other individual contributors and/or act as a cross-functional team lead
    $54k-72k yearly est. Auto-Apply 59d ago

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