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14 jobs
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3 days ago

Pharmacy Technician, Intermediate (Short Term Employment)

NewBe an early applicant North AmericaFull-time
United States

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…
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BSC
3 days ago

Care Management - Nurse, Senior (FEP - Triage)

NewBe an early applicant North AmericaFull-timeSenior
United States

Your Role 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…
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4 days ago

Utilization Management Nurse, Senior (Medicare Concurrent Review)

NewBe an early applicant North AmericaContractSenior
United States

Your Role The Utilization Management Concurrent Review team reviews the inpatient stays for our members and correctly applies guidelines for nationally recognized levels of care. The Utilization Management Concurrent…

Hipaa
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5 days ago

Medical Director, Utilization Management - Appeals & Grievances

New North AmericaFull-time
United States

Your Role The Medical Management team ensures that Blue Shield of California (BSC) is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in…
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BSC
2 views last week

Care Management - Nurse, Senior - Transplant

North AmericaContractSenior
United States

Your Role The Case Management team performs case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical…
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BSC
2 views last week

Medical Director, Arbitrations and Utilization Management (Part Time)

North AmericaPart-time
United States

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…
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BSC
1 views 2 weeks ago

Pharmacist, Principal- P&T

North AmericaPrincipal
United States

Your Role The Formulary Strategy and Pharmacy & Therapeutics team is responsible for formulary development, clinical evaluation of drugs, and support of the Pharmacy & Therapeutics (P&T) process to advance…

Analytics Program Management
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3 views 3 weeks ago

Appeals and Grievances - RN, Senior

North AmericaFull-timeSenior
United States

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal…

Corrective Action QoS
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3 views 3 weeks ago

Clinical Coding Analyst RN, Consultant

North AmericaContract
United States

Your Role The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events.…

Analytics Data Analytics Oracle Strategic Planning
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3 views 3 weeks ago

Care Management - Nurse, Senior

North AmericaContractSenior
United States

Your Role The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support…
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BSC
2 views 3 weeks ago

Behavioral Health Care Mgmt Clinician, Senior (Triage Line)

North AmericaSenior
United States

Your Role Reporting to the Manager, Care Management – Behavioral Health, the Behavioral Health Care Management Clinician, Senior primarily supports the Behavioral Health Triage Line (a behavioral health crisis and…

Emergency Response
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BSC
1 views 4 weeks ago

Manager, Pharmacist

North America
United States

Your Role The Clinical Pharmacy Programs team is responsible for the development, implementation, coordination, and assessment of pharmacy programs addressing medication therapy issues of Blue Shield of California…

Program Management
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BSC
3 views last month

Sr. Manager, Pharmacist (Formulary/PBM)

North AmericaSenior
United States

Your Role The Formulary Strategy and Management team develops and maintains formularies that support competitive health plan products, manage health care costs, and meet regulatory requirements across Commercial Large…
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BSC
2 views last month

Pharmacist, Principal

North AmericaContractPrincipal
United States

Your Role The Cost of Health Care (COHC) & Specialty Drug Management Pharmacy team is responsible for managing the Specialty Drug strategies across the pharmacy and medical benefit and leading and implementing cost…

Analytics Performance Management Strategic Planning Vendor Management
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