Blue Shield of California Jobs in Long Beach
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Blue Shield of California-Long Beach
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...
Blue Shield of California-Long Beach
coordinate, and evaluate pharmacoeconomic outcomes and value-based assessments to support formulary decision making. This role works with Clinical Pharmacists and others to support Blue Shield of California’s mission and strategy.
Your Work
In this role...
Blue Shield of California-Long Beach
chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease). Outreach to members with HEDIS Care Gaps to assist with closure
• Apply detailed knowledge of FEP PPO and Blue Shield of California's established medical/departmental...
Blue Shield of California-Long Beach
Quality Department to improve Blue Shield of California and Promise Health Plan quality performance for regulatory and accreditation requirements including National Committee for Quality Assurance, Centers for Medicare and Medicaid and Department...
Blue Shield of California-Long Beach
Your Role
The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events.. The Utilization Management Nurse,...
Blue Shield of California-Long Beach
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, Senior will report to the Utilization Management...
Blue Shield of California-Long Beach
Your Role
The 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 Appeals and Grievances RN Senior will report to the ...
Blue Shield of California-Long Beach
Your Role
The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care...
Blue Shield of California-Long Beach
Your Role
The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior LVN, Care Manager will report to the Manager of...
Blue Shield of California-Long Beach
Your Role
The Medi-Cal Analytics team supports the Medi-Cal Business Unit. The Medical Informatics Analyst - Consultant will report to the Senior Manager, Medical Informatics and will have a dotted reported line to the Special Populations Unit, that...
Blue Shield of California-Long Beach
Your Role
The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serve as an initial point of contact for providers and members in the medical management process by telephone or...
Blue Shield of California-Long Beach
Your Role
The Clinical Quality Analytics and Informatics team delivers best-in-class clinical quality analytics and informatics to enable high quality and affordable member-centered care. Our data, intelligence, and actionable insights help drive...
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