Large

Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. 

Blue Shield of California is a tax-paying, nonprofit, independent member of the Blue Shield Association with 4.7 million members, 7,800 employees, and $22.9 billion in annual revenue. 

Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. 

Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Finance

Blue Shield of California

#WeNeverStop #WhoWeStandFor #BlueShieldCares #WhatWeStandFor #QuienesSomos #SiempreAdelante #ProudToBeBSCA

You must have a bachelor's degree, 5+ years of relevant experience, Tableau data visualization skills, programming knowledge, call center data analysis experience, and a history of collaborative cross-functional teamwork.

You will analyze data, create reports, identify process improvement opportunities, and collaborate with business leaders to increase operational efficiency and automation.

Bachelors

Data

San Diego

Long Beach

Oakland

<ul><li>The Customer Experience – Insights team is responsible for all Operational Key Performance Indicator Reporting and Analysis for the Customer Experience Call Center teams. The Business Analyst, Senior will report to the Senior Manager, Insights Team. In this role you will support the Customer Experience (Member/Broker/Provider) Insights team with their performance reporting and data/analytics needs specifically to CE Quality initiatives (MTM/PG improvement). As a Team member within a shared service model, this role will be a key partner in providing detailed process/procedure analysis and complex reporting solutions that provide leaders with Insights that drive operational efficiencies and improve customer satisfaction.</li></ul>Your WorkIn this role, you will:<ul><li>Provide analytical support through the analysis and interpretation of data in support of cross-functional business operations</li><li>Works independently on complex projects/assignments that assist the organization in achieving operational targets</li><li>Develop, prepare, and analyze reports for management review, and present to various levels of management</li><li>Define business requirements and provide analysis to increase operational efficiency</li><li>Analyze actual results against plan and forecast and recommend interventions where appropriate</li><li>Support key business leaders and internal stakeholders to identify process improvement opportunities, devise data governance strategies, and automate insightful reports that provide meaningful analysis&nbsp;</li><li>Develop, automate, and maintain business operations reporting dashboards as required/defined by business leaders needs&nbsp;&nbsp;&nbsp;</li></ul>Your Knowledge and Experience<ul><li>Requires a bachelor’s degree or equivalent experience</li><li>Requires at least 5 years of prior relevant experience</li><li>Tableau Desktop Data Visualization/Dashboard development experience required</li><li>Previous experience/knowledge of programming with applications such as Microsoft SQL, Python, etc. strongly desired</li><li>Previous Call Center data analysis and operational support desired</li><li>Strong track record of implementing solution-oriented and transformational reporting that improves operational efficiencies</li><li>Strong track record of cross-functional collaboration and teamwork to accomplish strategic objectives</li></ul>

The Customer Experience – Insights team is responsible for all Operational Key Performance Indicator Reporting and Analysis for the Customer Experience Call Center teams. The Business Analyst, Senior will report to the Senior Manager, Insights Team. In this role you will support the Customer Experience (Member/Broker/Provider) Insights team with their performance reporting and data/analytics needs specifically to CE Quality initiatives (MTM/PG improvement). As a Team member within a shared service model, this role will be a key partner in providing detailed process/procedure analysis and complex reporting solutions that provide leaders with Insights that drive operational efficiencies and improve customer satisfaction.Your WorkIn this role, you will:Provide analytical support through the analysis and interpretation of data in support of cross-functional business operationsWorks independently on complex projects/assignments that assist the organization in achieving operational targetsDevelop, prepare, and analyze reports for management review, and present to various levels of managementDefine business requirements and provide analysis to increase operational efficiencyAnalyze actual results against plan and forecast and recommend interventions where appropriateSupport key business leaders and internal stakeholders to identify process improvement opportunities, devise data governance strategies, and automate insightful reports that provide meaningful analysis Develop, automate, and maintain business operations reporting dashboards as required/defined by business leaders needs   Your Knowledge and ExperienceRequires a bachelor’s degree or equivalent experienceRequires at least 5 years of prior relevant experienceTableau Desktop Data Visualization/Dashboard development experience requiredPrevious experience/knowledge of programming with applications such as Microsoft SQL, Python, etc. strongly desiredPrevious Call Center data analysis and operational support desiredStrong track record of implementing solution-oriented and transformational reporting that improves operational efficienciesStrong track record of cross-functional collaboration and teamwork to accomplish strategic objectives

Business Analyst, Senior - Blue Shield of California

Business Analyst, Senior

You need a PharmD degree, 8+ years in managed care, 3-5 years in management, active RPh license, great presentation skills, business acumen, MS Office proficiency.

You will oversee pharmacy accounts and sales support operations, develop strategies, manage team, ensure compliance, and promote pharmacy value proposition to clients.

Masters

Healthcare

The Sr. Manager, Pharmacy Accounts and Sales Support is responsible for the leadership of pharmacy accounts and Sales support team to support employer group account management and client renewal as well as new membership acquisition activities for fully insured and self-funded pharmacy membership. The position will also play a key role in supporting pharmacy product and initiative strategies development.&nbsp;In this role, you will:<ul><li>Provide oversight for the management of program area operations and employees</li><li>Be responsible for promotion and execution of overall vision, goals, objectives of the business unit</li><li>Provide oversight for the coordination of activities of the program area with other business units and monitor operational statistics to ensure all respective accreditation, regulatory and compliance requirements are met</li><li>Identify performance improvement opportunities to achieve or exceed benchmarks and advise on issues requiring immediate escalation</li><li>Provide oversight for the development, implementation, coordination, and assessment of programs to improve quality and cost-effectiveness</li><li>Partner with business unit teams to support planning and develop pharmacy strategies that align with business unit growth and profitability objectives&nbsp;</li><li>Partner with business unit sales and manage team to develop pharmacy request for proposal (RFP) strategies and responses</li><li>Partner with underwriting to develop Rx pricing and guarantee strategy approach for self-funded groups to improve competitive position</li><li>Lead development and maintenance of integrated pharmacy value story to support membership growth and retention</li><li>Manage team and work cross functionally as needed to manage and resolve client issues, respond to day to day client inquiries and ensure client contract guarantees and deliverables are met</li><li>Manage team to provide consultative support, and support development of training tools, presentations, sales collaterals on pharmacy product offerings and value proposition as needed to support sales</li><li>Active participation in client renewals, brokers meetings and finalist presentation as needed to promote pharmacy value proposition</li></ul>Your Knowledge and Experience<ul><li>Requires a Doctor of Pharmacy (PharmD) degree</li><li>Requires at least 8 years of experience in a managed care setting, including at least 3 – 5 years of management experience or equivalent</li><li>Requires a currently active and unrestricted California Registered Pharmacist (RPh) license</li><li>Prior experience in presenting pharmacy program value and observations to clients, brokers, consultants preferred</li><li>Prior experience in pharmacy benefit client contracting with understanding of contracting tactics and market place requirements preferred</li><li>Possesses excellent presentation, verbal and written skills with ability to understand and convey complex ideas to audience with diverse backgrounds</li><li>Possesses strong business acumen with proven experience in strategy development and planning</li><li>Must be proficient in MS&nbsp;Office, particularly MS Word, PowerPoint, and Excel</li></ul>

The Sr. Manager, Pharmacy Accounts and Sales Support is responsible for the leadership of pharmacy accounts and Sales support team to support employer group account management and client renewal as well as new membership acquisition activities for fully insured and self-funded pharmacy membership. The position will also play a key role in supporting pharmacy product and initiative strategies development. In this role, you will:Provide oversight for the management of program area operations and employeesBe responsible for promotion and execution of overall vision, goals, objectives of the business unitProvide oversight for the coordination of activities of the program area with other business units and monitor operational statistics to ensure all respective accreditation, regulatory and compliance requirements are metIdentify performance improvement opportunities to achieve or exceed benchmarks and advise on issues requiring immediate escalationProvide oversight for the development, implementation, coordination, and assessment of programs to improve quality and cost-effectivenessPartner with business unit teams to support planning and develop pharmacy strategies that align with business unit growth and profitability objectives Partner with business unit sales and manage team to develop pharmacy request for proposal (RFP) strategies and responsesPartner with underwriting to develop Rx pricing and guarantee strategy approach for self-funded groups to improve competitive positionLead development and maintenance of integrated pharmacy value story to support membership growth and retentionManage team and work cross functionally as needed to manage and resolve client issues, respond to day to day client inquiries and ensure client contract guarantees and deliverables are metManage team to provide consultative support, and support development of training tools, presentations, sales collaterals on pharmacy product offerings and value proposition as needed to support salesActive participation in client renewals, brokers meetings and finalist presentation as needed to promote pharmacy value propositionYour Knowledge and ExperienceRequires a Doctor of Pharmacy (PharmD) degreeRequires at least 8 years of experience in a managed care setting, including at least 3 – 5 years of management experience or equivalentRequires a currently active and unrestricted California Registered Pharmacist (RPh) licensePrior experience in presenting pharmacy program value and observations to clients, brokers, consultants preferredPrior experience in pharmacy benefit client contracting with understanding of contracting tactics and market place requirements preferredPossesses excellent presentation, verbal and written skills with ability to understand and convey complex ideas to audience with diverse backgroundsPossesses strong business acumen with proven experience in strategy development and planningMust be proficient in MS Office, particularly MS Word, PowerPoint, and Excel

Sr. Manager, Pharmacist (Pharmacy Accounts and Sales Support) - Blue Shield of California

Sr. Manager, Pharmacist (Pharmacy Accounts and Sales Support)

You must have 10+ years of Salesforce experience, Vlocity proficiency, Health Insurance knowledge, Agile expertise, and ability to collaborate effectively with stakeholders. Health Insurance experience and DevSecOps knowledge are preferred.

You will lead Salesforce application development projects, drive technical solutions, mentor team members, and collaborate with cross-functional teams to optimize solutions for Blue Shield of California’s growth and financial goals.

Software Engineering

Blue Shield of California is looking for a principal-level Application Developer to join our IT Application Services team. The candidate will be&nbsp;the subject matter expert for the Operations portfolio responsible for the definition &amp; ownership of our&nbsp;real-time streaming claim event processing services&nbsp;&amp; cloud integration platform.&nbsp;The Salesforce–Principal Developer will report to Manager-IT Development under the COE (Center Of Excellence) organization and will work with the matrixed portfolio and business teams. This individual will lead technical training, define &amp; enforce standards, and serve as the expert developer &amp; lead consultant responsible for assuring&nbsp;real-time solutions built within the portfolio are highly secure, performant, and robust.&nbsp;This includes effective communication &amp; influence of IT, business, and vendor partners to provide solutions that optimize&nbsp;cost, quality, security, and fit for purpose.Your WorkIn this role, you will:<ul><li>Lead the implementation of the tech design based on the Enterprise architecture and solution design.</li><li>Lead end to end solution delivery of small to medium scale projects to ensure the outcome design meets functional and non-functional requirements.</li><li>Review and analyze data to predict future needs and devises enhancements.</li><li>Act as the technical lead that drives the successful integration of application systems, projects and enhancements.</li><li>Instruct, direct, mentor, and monitor the technical work of projects senior staff.</li><li>Will be expected to be a technical champion and advocate for the optimization of Salesforce solutions needed to support Blue Shield’s growth and financial goals.</li><li>Will serve as IT representative in cross-organizational initiatives that serve to drive scale (growth), cost optimization, quality, and end-user experience.</li><li>Serve as technical owner for major initiatives impacting the Health Solutions portfolio - establishing trusted relationship with business partners, internal IT organization, other IT portfolio leaders, and key suppliers’ technical teams.</li><li>Lead solution design and development activities on concurrent complex projects with product, solution, and cross portfolio teams.</li><li>Provide technical leadership in establishing a competency center that educates other IT professionals on service &amp; cloud-based design &amp; development practices.</li><li>Demonstrate experience in seeking and locating information across the industry to understand new and related Salesforce.com technologies, including AppExchange and partner products.</li><li>Effectively communicate approach, value, risk, alternatives, and status of goal progress with executive &amp; senior management, business sponsors, and product managers.</li><li>Promote relevant software development tools, industry protocols, troubleshoot &amp; support procedures, monitor quality controls, and suggest improvements.</li><li>Self-directed, works with limited management direction and exercise considerable latitude in determining technical objectives of assignment.</li><li>Applies significant knowledge of IT and healthcare industry trends.</li><li>Should be able to demonstrate ability to formulate strategies, communicate and build alignment on concepts from ideation to execution.</li></ul>Your Knowledge and Experience<ul><li>Requires a bachelor's degree or equivalent experience.</li><li>Requires at least 10 years of prior relevant experience.</li><li>Hands-on design, coding, integration, and deployment experience in Salesforce, with minimum 3+ years of experience on Vlocity Industry-Cloud applications is required.</li><li>Experience in Vlocity application including OmniScripts, DataRaptors, Calculation Procedure, Rate matrices, Integration Procedure, Vlocity Templates, Vlocity Cards, Angular JS, JavaScript, CSS, HTML, and LWC is required.</li><li>End to end Vlocity project implementation experience is preferred.</li><li>Salesforce Custom application development with Integrations is a must.</li><li>Extensive experience in Salesforce configuration and development including Workflows, Process Builder, Apex (classes and triggers),&nbsp;Visual Force&nbsp;page, Lightning Components.</li><li>Salesforce Community implementation experience is preferred.</li><li>​Experience in Health Insurance, basic and advanced Rate Quote, Health Insurance data model and services is highly desirable. Should be able to understand product&nbsp;models and capabilities​.</li><li>Experience in Application Integration​, design and applying to the&nbsp;Vlocity&nbsp;techniques such as Integration Procedures, Apex​ is required.</li><li>Should possess very strong technical acumen &amp; deep working knowledge of Agile Methods, Service Architecture, and enterprise Cloud Integration.</li><li>Demonstrate required experience with advanced Salesforce.com development tools and techniques such as&nbsp;Apex, custom development, triggers, JavaScript, APIs, JSON, sObjects, SOQL, and SOSL.</li><li>Experience with interfaces using cloud platforms such as Azure or AWS is highly desirable.</li><li>Experience working with Source Controls, GitHub, Jenkins, Azure, AWS and other CI/CD pipeline utilities &amp; concept in a DevSecOps environment is highly desirable.</li><li>The ability to influence, collaborate, and build relationships with key stakeholders, vendors, and cross-functional teams is key to success.</li><li>Healthcare experience in Membership, Enrollment, Provider claims processing &amp; payments is preferred (Facets, FHIR).</li></ul>

Blue Shield of California is looking for a principal-level Application Developer to join our IT Application Services team. The candidate will be the subject matter expert for the Operations portfolio responsible for the definition & ownership of our real-time streaming claim event processing services & cloud integration platform. The Salesforce–Principal Developer will report to Manager-IT Development under the COE (Center Of Excellence) organization and will work with the matrixed portfolio and business teams. This individual will lead technical training, define & enforce standards, and serve as the expert developer & lead consultant responsible for assuring real-time solutions built within the portfolio are highly secure, performant, and robust. This includes effective communication & influence of IT, business, and vendor partners to provide solutions that optimize cost, quality, security, and fit for purpose.Your WorkIn this role, you will:Lead the implementation of the tech design based on the Enterprise architecture and solution design.Lead end to end solution delivery of small to medium scale projects to ensure the outcome design meets functional and non-functional requirements.Review and analyze data to predict future needs and devises enhancements.Act as the technical lead that drives the successful integration of application systems, projects and enhancements.Instruct, direct, mentor, and monitor the technical work of projects senior staff.Will be expected to be a technical champion and advocate for the optimization of Salesforce solutions needed to support Blue Shield’s growth and financial goals.Will serve as IT representative in cross-organizational initiatives that serve to drive scale (growth), cost optimization, quality, and end-user experience.Serve as technical owner for major initiatives impacting the Health Solutions portfolio - establishing trusted relationship with business partners, internal IT organization, other IT portfolio leaders, and key suppliers’ technical teams.Lead solution design and development activities on concurrent complex projects with product, solution, and cross portfolio teams.Provide technical leadership in establishing a competency center that educates other IT professionals on service & cloud-based design & development practices.Demonstrate experience in seeking and locating information across the industry to understand new and related Salesforce.com technologies, including AppExchange and partner products.Effectively communicate approach, value, risk, alternatives, and status of goal progress with executive & senior management, business sponsors, and product managers.Promote relevant software development tools, industry protocols, troubleshoot & support procedures, monitor quality controls, and suggest improvements.Self-directed, works with limited management direction and exercise considerable latitude in determining technical objectives of assignment.Applies significant knowledge of IT and healthcare industry trends.Should be able to demonstrate ability to formulate strategies, communicate and build alignment on concepts from ideation to execution.Your Knowledge and ExperienceRequires a bachelor's degree or equivalent experience.Requires at least 10 years of prior relevant experience.Hands-on design, coding, integration, and deployment experience in Salesforce, with minimum 3+ years of experience on Vlocity Industry-Cloud applications is required.Experience in Vlocity application including OmniScripts, DataRaptors, Calculation Procedure, Rate matrices, Integration Procedure, Vlocity Templates, Vlocity Cards, Angular JS, JavaScript, CSS, HTML, and LWC is required.End to end Vlocity project implementation experience is preferred.Salesforce Custom application development with Integrations is a must.Extensive experience in Salesforce configuration and development including Workflows, Process Builder, Apex (classes and triggers), Visual Force page, Lightning Components.Salesforce Community implementation experience is preferred.​Experience in Health Insurance, basic and advanced Rate Quote, Health Insurance data model and services is highly desirable. Should be able to understand product models and capabilities​.Experience in Application Integration​, design and applying to the Vlocity techniques such as Integration Procedures, Apex​ is required.Should possess very strong technical acumen & deep working knowledge of Agile Methods, Service Architecture, and enterprise Cloud Integration.Demonstrate required experience with advanced Salesforce.com development tools and techniques such as Apex, custom development, triggers, JavaScript, APIs, JSON, sObjects, SOQL, and SOSL.Experience with interfaces using cloud platforms such as Azure or AWS is highly desirable.Experience working with Source Controls, GitHub, Jenkins, Azure, AWS and other CI/CD pipeline utilities & concept in a DevSecOps environment is highly desirable.The ability to influence, collaborate, and build relationships with key stakeholders, vendors, and cross-functional teams is key to success.Healthcare experience in Membership, Enrollment, Provider claims processing & payments is preferred (Facets, FHIR).

Salesforce Application Developer, Principal - Blue Shield of California

Salesforce Application Developer, Principal

You need a bachelor’s degree with a minor in math, stats, or computer science, plus 2 years of actuarial experience. Must have pricing or network/contractual analysis experience.

You will be analyzing pricing, financial goals, and provider-level action plans, building models for quantifying financial gaps, performing actuarial analyses, developing reserves, and using statistical programming languages to improve risk prediction and forecasting.

Banking & Finance

In this role, you will:<ul><li>Be responsible for analytic work required to convert pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute</li><li>Build and update models that allow the actuarial team to quantify financial gaps and opportunities at a provider level</li><li>Conduct and develop analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and/or evaluates actuarial risk related analysis</li><li>Coordinate, prepare, perform and audit actuarial analyses to assist in the development of complex actuarial formulations leading to the recommendation of pricing, trending, reserving, provider reimbursement and/or risk assessment strategies</li><li>Perform data exploration using a combination of statistical programming languages (including, but not limited R, Python, SQL, SAS) and deploy predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficiencies</li></ul>Your Knowledge and Experience<ul><li>Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience</li><li>Requires at least 2 years of professional actuarial experience</li><li>Experience with pricing or network/contractual analysis is required</li></ul>

In this role, you will:Be responsible for analytic work required to convert pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can executeBuild and update models that allow the actuarial team to quantify financial gaps and opportunities at a provider levelConduct and develop analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and/or evaluates actuarial risk related analysisCoordinate, prepare, perform and audit actuarial analyses to assist in the development of complex actuarial formulations leading to the recommendation of pricing, trending, reserving, provider reimbursement and/or risk assessment strategiesPerform data exploration using a combination of statistical programming languages (including, but not limited R, Python, SQL, SAS) and deploy predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficienciesYour Knowledge and ExperienceRequires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experienceRequires at least 2 years of professional actuarial experienceExperience with pricing or network/contractual analysis is required

Actuarial Analyst, Experienced - Blue Shield of California

Actuarial Analyst, Experienced

You need 3+ years of experience in UM, understanding of TAT standards, and familiarity with prior authorization guidelines, particularly in pediatric care.

You will process authorizations, support case managers, input data, research eligibility, and provide administrative support for healthcare services at Blue Shield of California.

<ul><li>The Children’s Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and approved Blue Shield Medical Policies and Guidelines which align with nationally recognized standards. You will be responsible for working daily inventory, processing medical records and requests, fax intake, referral intake, and other duties as assigned.</li></ul>Your WorkIn this role, you will:<ul><li>Process faxed/phoned in authorizations, UM/CM requests and/or calls left on voicemail</li><li>Select support for Case Manager such as mailings, surveys</li><li>Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation</li><li>Support to Advanced/Specialist CSC</li><li>Assign initial EOA days, or triage to nurses, based on established workflow&nbsp;</li><li>Research member eligibility/benefits and provider networks&nbsp;</li><li>Provide operational support to ensure healthcare services are provided to member, employer, and providers</li><li>Serve as the initial point of contact for members and providers by telephone or correspondence</li><li>Within extension of authority, review specific CHP eligibility referrals</li><li>Process service authorization referrals and assist with system letters, requests for information and data entry</li><li>Provide administrative/clerical support to medical management</li></ul>Your Knowledge and Experience<ul><li>Requires basic job knowledge of systems and procedures obtained through prior work experience or education.&nbsp;</li><li>Typically, requires minimum of 3 years of experience. May require vocational or technical education in addition to prior work experience.</li><li>Requires UM regulatory TAT standards&nbsp;</li><li>Requires basic job knowledge of systems and procedures obtained through prior work experience or education</li><li>At least 1 year work experience within the Medical Care Solutions Utilization Management Department or a similar medical management department at a different payor, facility, or provider group</li><li>In-depth knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the inpatient, DME and/or Home Health areas related to children&nbsp;</li></ul>

The Children’s Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and approved Blue Shield Medical Policies and Guidelines which align with nationally recognized standards. You will be responsible for working daily inventory, processing medical records and requests, fax intake, referral intake, and other duties as assigned.Your WorkIn this role, you will:Process faxed/phoned in authorizations, UM/CM requests and/or calls left on voicemailSelect support for Case Manager such as mailings, surveysData entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creationSupport to Advanced/Specialist CSCAssign initial EOA days, or triage to nurses, based on established workflow Research member eligibility/benefits and provider networks Provide operational support to ensure healthcare services are provided to member, employer, and providersServe as the initial point of contact for members and providers by telephone or correspondenceWithin extension of authority, review specific CHP eligibility referralsProcess service authorization referrals and assist with system letters, requests for information and data entryProvide administrative/clerical support to medical managementYour Knowledge and ExperienceRequires basic job knowledge of systems and procedures obtained through prior work experience or education. Typically, requires minimum of 3 years of experience. May require vocational or technical education in addition to prior work experience.Requires UM regulatory TAT standards Requires basic job knowledge of systems and procedures obtained through prior work experience or educationAt least 1 year work experience within the Medical Care Solutions Utilization Management Department or a similar medical management department at a different payor, facility, or provider groupIn-depth knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the inpatient, DME and/or Home Health areas related to children 

Blue Shield of California

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