Blue Shield of California jobs in Rancho Cordova, CA

Your Role The Promise Payment Integrity team leads the research and identification of financial integrity opportunities for Medi-Cal, not limited to the recoupment of provider overpayments, reinforce compliant claims payment processes, and ensure accurate revenue oversight and reconciliation. The Principal Business Analyst will report to the Director of Medi-Cal Performance Optimization. In this role you will blend deep claims data expertise with Medicaid/Medi-Cal policy know-how to deliver near-term recoveries and long-term solutions. Your Knowledge and Experience Requires mastery level knowledge of job area typically obtained through advanced education combined with experience. May have deep knowledge of project management Requires a bachelors degree or equivalent experience Requires at least 10 years of prior relevant experience Requires SQL expertise; strong Excel; experience with a viz tool (Power BI/Tableau) preferred Requires hands-on experience with claims systems (preferably Facets) - benefit, pricing, provider/network, and code-edit constructs; able to partner on config and UAT Medical Coding knowledge: working mastery of ICD-10-CM/PCS, CPT/HCPCS, DRG, modifiers, NCCI, POS, revenue codes. Certifications (CPC, COC, CPMA) is preferred Medicaid/Medi-Cal payment policy familiarity (coordination of benefits, retro eligibility, rate/benefit nuances, prior auth, state policy bulletins) is preferred Prior experience in a California plan with Medi-Cal (DHCS) lines of business, exposure to vendor PI programs (post-pay, pre-pay, DRG validation, coding audits) and FWA/SIU collaboration is preferred Your Work In this role, you will: Develop and conduct evaluations and studies within limited time frames and produce analyses that are easy for non-technical persons to understand Apply advanced statistical methods, advanced analytics and modeling techniques, visualization techniques, and advanced programming to innovate our products and services Identify how our customers are using our products to make strategic decisions and generate/implement ideas to improve our products and services to allow even better decision support Identify & size opportunities: Mine medical claims (header/line), remits, authorization, and provider data to detect overpayment patterns (e.g., duplicate, unbundling, DRG upcoding, place-of-service, COB, retro eligibility, NCCI edits) Lead recoveries end-to-end: Validate hypotheses, quantify impact, document case logic, and route to recovery-letters, offsets, refund processing, and tracking-ensuring timely, compliant collections Root-cause & fix: Perform RCA on adjudication errors (pricing, benefits, provider setup, code edits, COB, policy gaps) and drive corrective actions in Facets configuration, claims editing, or business process changes (UAT + production readiness) Govern vendor & internal programs: Own the day-to-day of assigned PI programs (internal and vendor-supported), monitor KPIs, backlog, and quality, and escalate issues; convert one-off "finds" into durable edit/rules Regulatory alignment: Ensure recoveries and edits align to Medicaid/Medi-Cal rules and plan contracts; partner with Compliance/Legal on policy interpretation and provider communications Cross-functional leadership: Partner with Claims Ops, Provider Contracting, Medical Management, SIU/FWA, and Finance on implementation, appeals, and provider education; present results to leadership Reporting & storytelling: Build dashboards and narrative readouts: opportunity pipeline, identified/validated/recovered, yield, aging, and fix adoption

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 $16.90 to $17.50 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 16 - 22 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!

Your Role The End-to-End Member Experience Transformation and Health Plan Correspondence Output Management team is positioned to radically improve how we communicate with customers, aligning with our mission to make complex healthcare simple. The Administrative Assistant, Advance will report to the Senior Director, and support other peer Directors. In this role you will provide high-level administrative support to Directors / Senior Directors, managing complex calendars, travel arrangements, and confidential information. You will coordinate meetings, prepare reports and presentations, and act as a key liaison between leadership and internal or external stakeholders. Your Knowledge and Experience Requires a high school diploma or GED Requires at least 5 years of prior relevant experience Experience supporting senior leadership or multiple executives in a fast-paced environment Knowledge of project coordination tools (e.g., SharePoint, Teams, or similar platforms) Familiarity with budget tracking and reporting for departmental expenses Ability to identify and implement process improvements for administrative workflows Your Work In this role, you will: Be responsible for providing administrative support to functional area(s), department manager(s) and/or staff Use automated office equipment and business applications as needed such as PowerPoint, Excel, expense management and travel booking software Act as an information source on organization policies and procedures Assist with onboarding new employees Screen calls, take and deliver messages, provide information to callers Coordinate complex scheduling for meetings, events, and travel, including managing calendars across multiple executives Prepare and edit high-quality documents and presentations, ensuring accuracy and adherence to branding and compliance standards Manage confidential information with discretion and maintain sensitive records Serve as liaison between leadership and internal/external stakeholders, ensuring timely communication and follow-up Support expense reporting creation, approvals, and coordination, including tracking due dates/deadlines, and status updates Assist with executive communication, drafting emails or memos as needed

Your Role The Behavioral Health Operations Oversight team maintains program integrity and ensures compliance with regulatory and accreditation standards. The Program Coordinator, Experienced, will focus on Behavioral Health Mandates and Implementations and report to the Senior Manager, Program and Project Management of Behavioral Health Mandates and Implementation. In this role you will support Blue Shield of California's Behavioral Health program through mandate and implementation readiness efforts to meet federal and state requirements. 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 college degree or equivalent experience Requires 3 years of prior relevant experience Managed care/behavioral health compliance operations experience is preferred Regulatory implementation, compliance oversight, and operational risk management are preferred Strong organizational skills and time management skills Your Work In this role, you will: Be responsible for strategic alignment and integration across projects/programs, from initiation through delivery, in support of business unit process and administrative efficiency Participate cross-functionally in business planning to support business unit strategy Be responsible for large/complex projects/programs Exercise independent judgement in developing methods, techniques, and evaluation criterion for obtaining results Track regulatory implementations and mandates Manage risk register, including remediation plans Assist with regulatory filings Provide Federal Parity RFI support/back-up Fulfill additional assigned duties as directed

Your Role The Payment Integrity team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. Some examples of payment integrity include validating coding rules, determining the correct party, membership eligibility, contractual adherence, and conducting root cause analysis to prevent errors. This team is responsible for over $400M+ of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments. The Senior Business Analyst will report to the Director of Payment Integrity. In this role you will collaborate with various internal teams and vendors to improve the cost of healthcare and premium cost outcomes for our Behavioral Health program. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 5 years of prior relevant experience Ability to write SQL queries from scratch to accurately pull data required Knowledge and experience with behavioral health claims required In depth experience with payment integrity practices and related operations preferred Possess strong data/analytic, financial, and process experience Experience with Facets claims processing system is desired Your Work In this role, you will: Provide complex analytical support through the analysis and interpretation of data in support of cross-functional business operations Develop annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis) Develop, prepare, and analyze reports with complex analysis and data for management review, and present to various levels of management Define business requirements and provide analysis to increase operational efficiency Provide analytical support for multiple, complex cross-functional projects simultaneously; establish work plans and timelines Identify novel avenues of pursuit for the improvement of payment accuracy for behavioral health claims Work with internal teams and external vendors on complex initiatives aimed at achieving cost savings and increased effectiveness Validate payment integrity concepts for behavioral health claims through interpretation of provider contracts, review of regulatory guidelines, and system configuration Identify root causes of issues through data analysis and collaborate with other teams to reduce payment errors Participate in issue resolution by providing analytic support and collaborating with various internal stakeholders

Your Role We are seeking a highly skilled and knowledgeable Collaboration Engineer to join our dynamic IT team. The ideal candidate will have extensive experience with Exchange Hybrid, Exchange Online, Teams, OneDrive, SharePoint, Copilot, Email Archive, and other collaboration tools and services. This role will be integral in managing and optimizing our Microsoft 365 environment, ensuring seamless communication and collaboration across the organization. Your Knowledge and Experience Typically, requires a college degree or equivalent experience and minimum 7 years of prior relevant experience. Minimum of 5 years of experience in managing Exchange Hybrid and Exchange Online environments preferred Proficiency in Microsoft Teams, OneDrive, SharePoint, and other M365 collaboration tools. Experience with Copilot and its integration into workflow processes. Strong knowledge of email archiving solutions and best practices. Experience with virtual machine (VM) systems management. Strong understanding of MS Windows Server systems. Excellent troubleshooting and problem-solving skills. Strong verbal and written communication skills. Ability to work independently and collaboratively within a team. Familiarity with ServiceNow for IT service management. Experience working in an Agile environment. Relevant certifications such as Microsoft 365 Certified: Enterprise Administrator Expert, Microsoft Certified: Azure Solutions Architect Expert, or similar are highly desirable. Experience with PowerShell scripting for automation and management of M365 services. Familiarity with security and compliance requirements related to M365 services. Experience with other collaboration tools such as Slack, Zoom or Webex. Understanding of networking concepts and their relation to M365 services. Your Work In this role, you will: Design, implement, and manage Exchange Hybrid and Exchange Online environments. Ensure the smooth operation and maintenance of Microsoft Teams, OneDrive, SharePoint, and other collaboration tools. Utilize Copilot to enhance productivity and streamline workflow processes. Manage and maintain email archiving solutions, ensuring data integrity and compliance. Troubleshoot and resolve issues related to M365 services and collaboration tools. Develop and maintain comprehensive documentation for configurations, processes, and procedures. Collaborate with other IT teams to integrate M365 services with existing infrastructure. Stay up-to-date with the latest M365 features, updates, and best practices. Conduct training and provide support to end-users to maximize the utilization of M365 services. Perform regular system monitoring, audit and generate reports on system performance and usage.

Your Role Work Schedule: Monday - Thursday 10:30am-7pm; Friday 9:30am-6pm 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. The Federal Employee Program (FEP) team 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. Your Knowledge and Experience Requires a current CA RN License Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements Requires at least 5 years of prior experience in nursing, healthcare or related field Bachelor of Science in Nursing or advanced degree preferred. Requires relevant behavioral health experience. Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources. Able to operate PC-based software programs including proficiency in Word and Excel. Strong clinical documentation skills, independent problem identification and resolution skills. Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills. Competent understanding of NCQA and federal regulatory requirements. Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable. Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care. Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making. Your Work In this role, you will: Coordinates care for Lower Level of Care such as Residential Treatment, Partial Hospitalization Program, Intensive Outpatient Program, other outpatient services, and community programs as appropriate. Research and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes Initiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settings Applies detailed knowledge of FEP PPO and Blue Shield of California's (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. Provides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease). Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member's needs related to behavioral health. Must be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentation.

Your Role The End-to-End Member Experience Transformation and Health Plan Correspondence Output Management team is positioned to radically improve how we communicate with customers, aligning with our mission to make complex healthcare simple. The Strategic Planning & Performance Principal will report to the Senior Director and lead stakeholder engagement internally and with vendors, driving quality interactions, transparency, and performance oversight. This role requires solving complex challenges through innovative, scalable, and sustainable solutions, operating cross-functionally to meet success criteria while building a strong community of practice and standards across the transformation portfolio. Candidates must demonstrate proven business process, analytical, interpersonal, and communication skills, with the ability to work independently and execute flawlessly. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 10 years of prior relevant experience Strong internal and external customer focus is a must Outstanding conceptual, analytical, and problem-solving skills Advanced skills in analytics / tool design with a record of implementing process tools and/or decision support mechanisms Strong written and verbal communication, planning and organization skills Mastery level PowerPoint and Excel skills a must Must be detail, deadline and results-oriented Must have excellent problem-solving skills Must be proactive and exhibit initiative Demonstrates exceptional interpersonal skills - able to work with a variety of individuals and teams Ability to adapt to rapidly changing demands; thrives in a dynamic environment Your Work In this role, you will: Be responsible for planning and implementation of complex programs spanning across business areas which include encompass multiple projects, initiatives, and where analysis requires evaluation of intangible variance factors Ensure strategic direction of program is in line and designs strategies for alignment with goals and objectives Be responsible for facilitating annual strategic planning process Work in conjunction with financial partner's complete business planning and forecasting Manage budget planning as part of the annual budget cycle Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California strategic goals Consult with all levels including senior management, make recommendations, and influence decision-making Leverage cross-functional internal and external relationships to drive initiatives forward Plan and implement multiple monthly business reviews spanning across business areas, vendor services, and output functions Determine key business issues, develop effective action plans and implement successful conclusions within monthly business reviews Provide consistent work planning, communications and assessments of contract compliance gaps of vendors to minimize overall risk Maintain records of process and control validation to support internal and external audits of BSC in addition to those functions delegated to our vendors Serves as primary contact for internal and external audits that arise Coordinate responses and resolutions/escalation inquiries Responsible for ensuring consistency and sustainability of governance program across all output vendors Responsible for cross-functional support, development and oversight of monthly vendor scorecards and quarterly business reviews (or QBRs) Implement and create standardized reports for leadership to track compliance, audit results and overall risk Must be able to review and analyze various metrics and offer solutions to improve results Responsible for participating in any compliance, audit, oversight or regulatory committees

Your Role The IT Health Solutions Health Data Strategy team is responsible for delivering on 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. Your Knowledge and Experience Bachelor's degree in Computer Science, Information Technology, Management Information Systems, or a related field (or equivalent experience), with a minimum of 7 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 Strong scripting and automation skills using tools such as PowerShell, ANT, Jython, Python, InstallShield, and SCCM, with experience in automating builds, deployments, and configurations. Expertise 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. Solid SQL/PL-SQL knowledge and strong experience with API development and integrations using Java and other tools. Proficiency 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/ Excellent ability to influence and 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. Your Work In this role, you will: 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 Drive operational excellence, including but not limited to Incident Management, process automation leveraging AI, and ensuring smooth deployments for your technology products/platform features. Recommend 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. Coordinate sustaining support for multiple application platforms or business processes, ensuring seamless integration and operation in a cloud environment. Possesses and applies a broad range of expertise of principles and practices for the complex of complex assignments and for leading team members Recommends and pursues improvements to processes to enhance application functionality and reliability Be self-directed, work with limited management direction and exercise considerable latitude in determining the technical objectives of the assignment. Apply significant knowledge of IT and healthcare industry trends. Facilitates training for team members and guides them as required Has strong communication skills and can speak to all levels within the organization Has overall technical responsibility for the applications/interfaces/processes within their domain

Your Role The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Vision Director will report to the Medical Director, Operations. In this role you will provide leadership and guidance on vision specialty program for Blue Shield of California. The Vision Director provides clinical expertise and consultative support to the organization related to vision services. Moreover, the Vision Director meaningfully contributes to the Blue Shield priorities and transformative initiatives that continue to improve the health and wellbeing of Blue Shield of California members. You will also provide direction and leadership in compliance with state and federal laws and regulatory requirements related to vision specialty. This is a Part Time position with 40 hours per pay period. Your Knowledge and Experience Doctor of Optometry (OD) degree is required Active, unrestricted Optometry license in the state of California required Fellow of the American Academy of Optometry (FAAO) preferred Minimum 5 years direct patient care experience Completed Optometry residency training 5 years' experience in managed care that can contribute to utilization management, and/or quality improvement activities or other health care administrative operations at the IPA or health plan level is preferred Knowledge of Medicare, California statutes and regulations including DMHC. Understanding of NCQA accreditation standards preferred An ability to work independently to achieve objectives and resolve issues in ambiguous circumstances Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communications Strong collaboration skills to effectively work within a team that may consist of diverse individuals who bring a variety of different skills ranging from medical to project management and more Excellent written and verbal communication skills Excellent analytical, time management and organizational skills Your Work In this role, you will: Provide Clinical oversight of vision specialty program and vision services vendors Establish a utilization matrix and provide an annual review of vision benefits. Ensure vision integration for utilization management and care management. Serve as a vision thought leader within the organization and act as subject matter expert and advisor for product strategy, emerging technology trends, public policy, and mandates. Serve as the primary representative and as an active participant in Compliance Committee, Vendor Partner Quality Committee, Joint Operation Committee meetings, and other meetings or industry-related events as appropriate. Drive regulatory compliance adherence and leads corrective action efforts with vendors and medical operations teams. Complete assigned vision services clinical reviews on Appeals and Grievances within compliance standards and provide recommendations based on appeals, grievances, and dispute trend Attend other meetings or industry related events as appropriate Attend mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class Comply with local, state, and federal laws, statutes and regulatory requirements related to vision plan services Contribute content regarding vision marketing collaterals and draft and author vision articles on behalf of BSC Any other assigned duties

Your Role The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquires. The Pharmacy Technician, Intermediate will report to the Supervisor, Pharmacy Services Operations. In this role you will resolve outpatient pharmacy benefit coverage inquiries, including prescription claim processing problems, and communication of drug formulary guidelines and alternatives. *Please note that this is a Temporary Full-time position with an expected assignment end date of 4/30/26. Your Knowledge and Experience Requires a California Certified Pharmacy Technician license Requires 2 years of pharmacy related experience and training; or equivalent combination of education and experience Basic understanding of internal procedures and policies needed to ensure effective execution of assigned tasks Ability to multi-task, set priorities, and manage time effectively Strong phone and verbal communication skills along with active listening skills Your Work In this role, you will: Coordinate, assist in, and support implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit Evaluate prior authorization requests based on medication policy and operational principles Provide drug usage history and other pertinent pharmacy benefit related inquiries to internal business partners to assist in case specific reviews and drug evaluations Communicate with the physician, physician's office staff, pharmacies, and internal business partners to assist with accurate and efficient resolution of pharmacy benefit inquiries Clearly communicate formulary alternatives and prior authorization criteria, and discusses pharmacy benefit coverage when required

Your Role The Workforce Management team partners with operations to ensure the contact centers are staffed appropriately to meet KPI's while looking for opportunities to gain efficiency. The Workforce Optimization Analyst will report to the Sr. Manager of WFM. In this role you will analyze contact center trends, including call volumes, offline inventory, and call patterns to forecast workload needed to support various channels. The analyst will develop KPI reports and communicate with leaders on opportunities and risks to performance. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 7 years of prior relevant experience Requires experience in scheduling, forecasting or capacity planning to include advanced utilization of workforce management tools & data analysis tools, telecommunications tools, contact routing and workload delivery systems. Requires Advanced Microsoft Excel skills to include pivot tables, formula usage, etc. Experience in Contact Center and back-office processing Environments required Preferred 4+ years' experience demonstrating application of mathematical and analytical skills, problem-solving, and forecasting methodologies applicable to workload forecasting including correlation modeling Preferred Working knowledge of Verint Workforce Management Software Your Work In this role, you will: Coach team members and acts as a functional SME Anticipate and handle critical situations with solid business solutions Analyze all CE operational workflows where inventory and/or call volumes dictate staffing/resources needs contact center trends (including call volumes and call patterns), claims and membership inventory to forecast workload needed to support various channels Ensure member service needs are met through accurate forecasting in support of various business areas Provide data and additional information to be used for capacity planning Delivers results of analysis and recommendations to various business partners and leadership to support the Blue Shield of California mission Create long term and short-term forecasts Utilizes data from various workforce management tools to provide in-depth analysis of workload factors for lines of business with basic to highly complex member contact areas and/or back-office functions. May instruct, guide and oversee the work of lower-level professionals and/or non-exempt staff. Works closely with operations leaders to understand headcount levels, helps develop hiring plans and maintain staff plans.

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 between $17.25-$17.50 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 5-9 hours per week. Availability the week before and after major holidays, which may include weekends is . 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 passing a 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.

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

Your Role This role supports Stellarus within the Ascendiun Family of Companies. The Risk Management & Controls Assurance team delivers actionable insights by quantifying IT and business risk to increase resilience while driving a security culture. This Program Manager, Principal role will report to the Senior Manager. In this role you will develop, provide oversight, and support a governance process to ensure compliance of the Technology Ownership & Accountability policy. 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 Experience in portfolio management, preferably within an Agile or SAFe environment, scrum master experience is a plus Experience partnering with all levels of management required Driven, energetic, team player with superior oral and written communication skills Organizational change management skills desired Requires deep understanding of IT control frameworks such as NIST, COBIT, ISO27001 to drive ownership and compliance in safeguarding assets and data Desire one or more of the following: CRISC (Certified in Risk and Information Systems Control), CISM (Certified Information Security Manager), CISA (Certified Information Systems Auditor), CISSP (Certified Information Systems Security Professional) #LI-FB1 Your Work In this role, you will: Program Leadership Operate at a strategic business level to ensure initiatives are in line with Stellarus strategic goals Consult with all levels including senior management, make recommendations, and influence decision-making Program Execution Coordinate with leadership and build business cases to support short-term and long-term goals 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 Work with Finance and IT leadership to define financial investment model for technologies based on levers such as risk reduction and cost savings Governance & Compliance Partner with teams across IT to design and implement an IT technology ownership governance process Oversee and manage said governance process, including key performance indicators and objective and key risks Drive risk mitigation of IT controls to ensure application security Process & Technology Risk Reduction Coordinate and build process/artificial intelligence agents to support application of critical controls in reducing technology risks and increasing business resiliency. Coordinate and build process/AI agents to support application of controls to reduce risk and increase technology resiliency Partner with Risk Management team to define security control baseline & ensure applications adhere to said baseline Lean -Agile Enablement Promote Lean-Agile principles to enable business agility, focusing on alignment, transparency, respect for people, and relentless improvement Other duties as assigned

Your Role The Information Security, Risk, and ISM team is undergoing a transformative shift-from traditional, manual operations to a fully autonomous, agentic AI-driven model. As an AI Developer, you will report to the Sr. Director of Information Security and play a pivotal role in designing and deploying intelligent agents that automate and enhance security, risk, and compliance functions across the enterprise. This high-impact role will accelerate the modernization of security operations, enable real-time decision-making, and support broader adoption of agentic AI across business units. You'll collaborate with cross-functional teams to build scalable AI systems that drive operational excellence, reduce manual overhead, and foster a culture of innovation. We are looking for a leader energized by creative problem-solving, building high-performing systems, and shaping the future of AI in enterprise security and risk management. Your Knowledge and Experience Required Requires a college degree or equivalent experience and minimum 10 years of prior relevant experience. 5+ years of experience in AI/ML development, with a focus on agentic systems or autonomous workflows. Proficiency in Python, TensorFlow/PyTorch, and LLM frameworks (e.g., OpenAI, Anthropic, Google, Meta, etc.). Experience integrating AI with cloud platforms (full gitops), enterprise security and IT service management tools. Excellent communication, organizational, and analytical skills. Preferred Experience building AI agents for security operations or GRC automation. Familiarity with vector databases, RAG pipelines, and semantic search. Background in healthcare technology or other regulated industries. Advanced degree in Computer Science, Cybersecurity, or related field. Understanding of cybersecurity principles, risk frameworks (e.g., NIST 800-53 & AI 100-1, OWASP GenAI Security Project, ISO 27001, etc.), and compliance standards. Your Work In this role, you will: AI System Development & Integration Design and implement autonomous AI agents to perform core InfoSec, Risk, and ISM functions. Integrate AI models with existing platforms (SIEM, GRC, IAM, cloud infrastructure). Build scalable, reusable AI components and orchestration frameworks. Security & Risk Intelligence Develop AI-driven mechanisms for continuous risk assessment and predictive threat modeling. Enable real-time decision support and automated incident response. Apply LLMs and multi-agent systems to enhance security workflows. Enterprise Enablement Partner with business units to identify opportunities for agentic AI adoption. Support change management and enterprise readiness for AI integration. Contribute to AI governance, ethical use, and compliance frameworks. Innovation & Thought Leadership Prototype and test novel AI approaches to improve operational resilience. Stay current on emerging AI technologies and their implications for cybersecurity. Advocate for AI-first thinking across the organization. Stakeholder Engagement Collaborate with internal teams (Legal, IT, Product, Engineering, HR) to align AI initiatives. Support external engagements with regulators, auditors, and partners. Ensure consistent messaging and alignment across internal and external communications.

Your Role The Utilization Management team reviews 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. Your Knowledge and Experience Bachelors of Science in Nursing or advanced degree preferred. Requires a current California RN License Requires at least 5 years of prior relevant experience Requires strong communication and computer navigation skills Desires strong teamwork and collaboration skills Requires independent motivation and strong work ethic Requires strong critical thinking skills Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEP Conducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliance Ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity and determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost-appropriate DC planning Prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination and communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirements Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate Refer to Case Management when there are acute inpatient needs affecting discharge Attend staff meetings, clinical rounds and weekly huddles Maintain quality and productivity metrics for all casework Buddy or support new employees Maintaining HIPAA compliant workspace for telework environment

Your Role The Middle Market Accounts team serves customers between the 101 - 2999 eligible employee segment. The Account Manager - Middle Markets, Senior will report to the Senior Manager, Account Management - Middle Markets. In this role you will be responsible for strategically maintaining and growing the organization's relationship with clients and brokers. While focusing on protecting and growing existing revenue streams by ensuring a high level of customer satisfaction, and will be done through strategic planning, identifying new revenue opportunities, cross-selling existing and new products, and monitoring market and economic conditions that may affect the client's operations and purchasing decisions. This position is located in the Central Valley area and has broker assignments throughout various counties, and travel will be required to maintain our presence in the market, but it will be mostly regional in nature. The job accommodates workplace flexibility, but some in-office presence will be required. Your Knowledge and Experience Requires at least 5 years of prior relevant experience Requires at least 3 years of Health Plan sales experience Requires a bachelor's degree or equivalent experience Requires a current active life and health license with the California Department of Insurance Experience negotiating with brokers and consultants (low complexity) with general understanding of the renewal process and can reach out to underwriting for quotes and pricing inquiries required Experience using available resources to complete back-office tasks and solve problems required Experience resolving service-related client issues required Your Work In this role, you will: Negotiate with brokers/consultant (medium and high complexity) with general understanding of the renewal process and can reach out to underwriting for quotes and pricing inquiries Use general knowledge of Blue Shield of CA products: TRIO, Tandem PPO, ASO, Specialty and has some knowledge on how they compare to competitive offerings to support accounts Use general understanding of Blue Shield of CA and Blue Shield of CA product value propositions based on client buyer type to support accounts Use general understanding of upcoming developments in the healthcare market (healthcare reform, state and local healthcare legislation, new entrants, customer need shifts) Clearly articulate thoughts and present Blue Shield of CA prepared presentation decks Build client relationships through brokers and communicate with non-executive decision makers Update Shield Link with accurate, thorough, and timely information

Your Role The Installation and Billing team provides support to over 3.5M members and collects 14.5B annually across 9 lines of business to ensure accurate and timely management of enrollment and premium billing. The Product Manager, Principal will report to the Director of Program and Project Management. In this role you will be setting the strategy for 4 products within the operations portfolio, leading the product owners and business analysts to drive improvements to our enrollment systems and technology that support cost savings, process efficiencies, compliance and incident reduction. Your Knowledge and Experience Requires a bachelor's degree (MBA preferred) or equivalent experience. Requires 10 years of experience in Product Management, Business Strategy Leadership, Management Consulting, or Entrepreneurship. Requires Scaled Agile (SAFe) Framework certification(s): SAFe Agilist, Program Consultant (SPC), or Product Owner/Product Manager (PO/PM) or Agile Product Management (APM). Your Work In this role, you will: Define the product strategy, vision, and roadmaps to align strategy to BSC's strategic themes and business outcomes. Define and prioritize solutions and capabilities required to meet customer needs in alignment with BSC's strategy, business goals, Objectives Key Results (OKRs), investment criteria and the strategy to execution process. Identify and define internal and/or external customer needs for a given BSC operational value-stream aligned Agile Product. Manage and plan the product features through the product development lifecycle and value stream. Conduct and apply primary and secondary market research to understand end-user needs to inform overall product strategy and design to maximize the delivery of value to the enterprise and customers/end users. Lead through change and develop strong partnerships and processes with Stellarus for effective product management. Drive priority, root cause analysis and resolution to incidents. Leads, directs and reviews the work of team members to accomplish operational plans and results within schedule and budget.