Horizon blue cross blue shield jobs in Colton, California (CA) State

Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providers. The Medical Director will review pre- and post-service requests and render decisions based on the member’s benefits, medical necessity, Blue Shield of California medical policy as well as l...

The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence.The CSC will interact telephonically with mem...

As a not-for-profit organization, Medavie oversees Medavie Blue Cross, a premier all-in-one benefits carrier and public health program administrator, and Medavie Health Services, a national primary health care solutions organization and the largest contracted provider of emergency management serv...

The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care.They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus ...

Depuis plus de 75 ans, Croix Bleue Medavie est un partenaire reconnu en matière de santé et de bien-être pour les particuliers, les employeurs et les gouvernements à l’échelle du Canada.En tant qu’organisme sans but lucratif, nous sommes fiers d’investir dans nos collectivités afin de lutter cont...

In this role you will support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products. Improve and maintain accuracy and integrity of new and existing provider contracts to ensure efficiency in contract administration that will support unit costs sa...

For over 75 years, Medavie Blue Cross has been a leading health and wellness partner for individuals, employers and governments across Canada. Group Underwriting team to ensure Medavie Blue Cross achieves its financial targets on the group health, life and disability income lines of business. Our...

Initiation of timely individualized care plans (ICP) based on applicable assessments and assisting in transitions of care across all ages. ...

La Compagnie d’Assurance-vie Croix Bleue du Canada est une entreprise sous réglementation fédérale qui distribue ses produits par l’intermédiaire des différentes Croix Bleue.Elle se spécialise dans les produits d’assurance vie, de prestations du vivant et d’assurance invalidité qui viennent compl...

The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence.The CSC will interact telephonically with mem...

Plan and coordinate simple to moderatly complex projects and activities with team members and any stakeholders both internal to Medavie Blue Cross and external clients. ...

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 delegate...

What makes us a different kind of employer?.As a national health solutions partner, Medavie is committed to improving the wellbeing of Canadians — and in our digital-first culture, technology is key to providing the products, services and solutions that increase access to care and improve health ...

The Data and Analytics (D&A) organization focuses enterprise-wide to partner with business stakeholders to apply the power of data & analytics to deliver new insights and data-driven solutions to accelerate business outcomes.The Data Services & Solutions team is part of the centralized D&A organi...

Demonstrate thought leadership and champion the product vision and product across BSC. Partner with cross-functional leaders and team members to resolve escalated issues. ...

In this role you will design, develop, and execute automation and manual testing in Integration, Functional and Regression testing team covering QA functions across multiple applications like Facets custom & core configuration, EDI, interfaces. ...

Participate in a cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region . Support initiatives to improve and maintain highly competitive unit costs across all products to ensure that a superior provider network is available to all em...

This position will have a pivotal role in supporting the ongoing building and execution of enterprise and business-unit level strategies to strengthen Blue Shield of California’s ability to transform healthcare. Create executive materials to maintain clear, succinct, and meaningful communication ...

The Cloud Engineering team is a cross functional group responsible for the advancement and support of the Blue Shield multi cloud presence. In this role you will have a broad and deep impact on how Blue Shield achieves its business and technical goals by leveraging cloud technologies within moder...

Support the implementation and enhance agile standards across enterprise. ...

Participate in cross-functional teams across multiple business units to align on priorities and work on the execution of materials to be developed. This includes supporting marketing campaigns through development across multiple channels. Execute deliverables by deadline and on budget, which incl...

The Blue Shield of California Finance team is responsible for providing Line of Business consolidation, reporting, and analysis support for the Growth Finance team. Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business op...

The Centers of Excellence (COE) Systems Analyst team defines and deliver solutions that meet business objectives and will serve as a facilitator between the business and IT in understanding the business needs; leads eliciting, analyzing, validating, and managing requirements, processes, and high-...

Complete a broad variety of administrative tasks including managing an active calendar; composing and preparing correspondence; arranging meeting agendas; scheduling and calendaring meetings.Be responsible for providing analytical and specialized administrative support .Use automated office equip...