Manager, Utilization Management Nurse Management
El Dorado Hills, California
Your Role The Utilization Management team reviews inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care for our Shared Services department including concurrent review, transplant and N...
2d
| Job Type | Full Time |
Medical Director, Behavioral Health
Baltimore, Maryland
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 Medical Director, Behavioral...
2d
| Job Type | Full Time |
Clinical Services Coordinator, Intermediate (BH Specialty Team)
Woodland Hills, California
Your Role The Behavioral Health Services (BHS) Specialty team manages continuity of care (CoC) requests, exception requests, and provides support for the clinical Behavioral Health Utilization Management team. The Behavioral Health (BH) Cli...
2d
| Job Type | Full Time |
Behavioral Health Utilization Management Clinician, Experienced
Lodi, California
Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal cr...
2d
| Job Type | Full Time |
Dental Director, Clinical Advisor
Rancho Cordova, California
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 Dental Director will report ...
2d
| Job Type | Full Time |
Behavioral Health Utilization Management Clinician, Senior
Woodland Hills, California
Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal cr...
2d
| Job Type | Full Time |
Utilization Management Nurse, Senior (Behavioral Health Post-Service Review)
San Diego, California
Your Role The Commercial Post Service Review team is responsible for clinically reviewing claims that are the result of a claim denial. The Commercial Post Service Review RN will report to the Manager, Post Service. In this role you will pe...
2d
| Job Type | Full Time |
Sr. Director, Clinical Quality
San Francisco, California
Your Role Reporting to the VP, Quality, the role of the Sr Director is critical to the success of Blue Shield of California and the Clinical Quality department in realizing its goals and objectives. This individual will play a key role as p...
2d
| Job Type | Full Time |
Medical Affairs Strategy, Senior Medical Director - Heme (Hybrid)
Boston, Massachusetts
Vertex Pharmaceuticals Incorporated
Job Description General Summary: Vertex seeks a dynamic and experienced Medical Affairs Physician/ Senior Medical Director for our Disease Area of Hematology within the Medical Affairs Strategy group. This individual will be responsible for...
2d
| Job Type | Full Time |
The Medical Director is responsible for providing oversight, medical guidance and support to the full spectrum of WellSky's clinical management acute, emergency department, and post-acute care solutions and programs. The scope of this job i...
2d
| Job Type | Full Time |