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 f

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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 f

Your Role The Social Services Representative, Advanced will report to the Supervisor, Social Services. In this role you will provide telephonic social services support and resource referrals for high acuity Blue Shield Promise members, in addition to administrative support to the Social Services Management Team. The Social Services Representative regularly reaches out to

Your Role The Delegation Oversight Utilization Management team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting that track and compare patters of delegated entities. The Delegation Operations Nurse Auditor LVN Experience

Your Role The Innovation Analyst, Consultant is responsible for supporting the improvement and maintenance of our integrated enterprise strategy to execution process and supporting initiatives designed to provide strategic thought leadership to business leaders across the enterprise to address ambiguous problems and opportunities. This role will serve as a change agent, l

Duties WHAT IS THE SMALL BUSINESS SELF EMPLOYED (SBSE) DIVISION? A description of the business units can be found at Vacancies will be filled in the following specialty area 5 vacancies in SB/SE Deputy Commissioner Exam, Specialty Examination, Estate & Gift/Excise Tax 1 vacancy in SB/SE Deputy Commissioner Exam Headquarters Exam; Exam Case Selection The following are the

Your Role The Medical Care Solutions Clinical Service Intake team responsible for timely and accurate processing of Treatment Authorization Request. The Clinical Services Coordinator will report to the Supervisor of Clinical Services Intake. In this role you will be for supporting clinical staff day to day operations for Promise lines of business. Your Work In this role,

Duties WHAT IS THE INFORMATION TECHNOLOGY (IT) DIVISION? A description of the business units can be found at Vacancies will be filled in the following specialty areas Information Technology The following are the duties of this position at the full working level. Provides direction for monitoring all program phases to integrate existing and future systems into new business

Your Role The Network Performance Analysis and Contracts is part of the Provider Partnerships & Network Management Division and focuses on provider network performance analysis, reporting, and consulting. The Data Analyst Health, Experienced will report to the Manager, Data Analysis. In this role you will provide analytical support through the analysis and interpretation

Duties WHAT IS THE INFORMATION TECHNOLOGY DIVISION? A description of the business units can be found at Twenty One (21) vacancies will be filled in the following specialty areas Anywhere within Information Technology. The following are the duties of this position at the full working level. If this vacancy includes more than one grade and you are selected at a lower grade

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities in collaboration with members and those involved with members' care including registered nurse case managers, social workers, dietitians, health coaches, pharmacists, and physicians. The FEP Health Coach will report to the FEP Department Manage

Duties WHAT ARE THE SMALL BUSINESS SELF EMPLOYED (SB/SE), LARGE BUSINESS AND INTERNATIONAL (LB&I), AND TAX EXEMPT AND GOVERNMENT ENTITIES (TE/GE) DIVISIONS? A description of the business units can be found at Vacancies will be filled in the following specialty areas SBSE (Exam and Collection), LB&I, and TEGE The following are the duties of this position at the full workin

Your Role The Social Services Representative, Advanced will report to the Supervisor, Social Services. In this role you will provide telephonic social services support and resource referrals for high acuity Blue Shield Promise members, in addition to administrative support to the Social Services Management Team. The Social Services Representative regularly reaches out to

Duties WHAT IS THE INFORMATION TECHNOLOGY DIVISION? A description of the business units can be found at Vacancies will be filled in the following specialty areas Information Technology The following are the duties of this position at the full working level. As a senior expert and consultant to top agency management officials, the employee advises on integrating IT program