Before you apply to a job, select your language preference from the options available at the top right of this page.Explore your next opportunity at a Fortune Global 500 organization. Envision innovative possibilities, experience our rewarding culture, and work with talented teams that help you become better every day. We know what it takes to lead UPS into tomorrow—people with a unique combination of skill + passion. If you have the qualities and drive to lead yourself or teams, there are roles ready to cultivate your skills and take you to the next level.Job Description:Location:11800 Harlan Rd.Lathrop, CA 95330Hours Vary: 18:00 - 23:00Monday Through FridayJob SummaryThis position supervises, trains, develops, and holds workgroups responsible for safety, production and attendance. He/She sets and maintains high standards for integrity, accountability, account productivity, accuracy, customer service, organization, communication, cooperation, and safety. This position provides innovative and effective leadership and cultivates a functional working relationship with all levels of personnel throughout the organization.Responsibilities:Develops and maintains good working relationships with employees, management, and customers.Facilitates training with new and current employees.Ensures all employees adhere to safety policies and procedures at all times, operating in full compliance with department, station, corporate and local government requirements.Manages department resources to ensure maximum output, accuracy, and efficiency at all times.Establishes and promotes a positive, team-oriented work environment emphasizing employee involvement, pro-active communication, inter-departmental cooperation, and continual improvement on all levels.Implements employee personal development plans as required to ensure the continuing professional growth of department personnel.Ensures all department employees receive specific and detailed orientation, skills and safety training, appropriate materials and information, regular evaluations, and pro-active coaching to support their continued development.Ensures all employees adhere to safety policies and procedures at all times.Qualifications:Bachelor's Degree or International equivalent - PreferredAbility to lift 70 lbs./32 kgs.Availability to work flexible shift hours, Five days per weekStrong oral and written communication skillsWorking knowledge of Microsoft OfficeAbility to work in a fast-paced warehouse environmentManagement experience - PreferredEmployee Type:PermanentUPS is committed to providing a workplace free of discrimination, harassment, and retaliation.Other Criteria:UPS is an equal opportunity employer. UPS does not discriminate on the basis of race/color/religion/sex/national origin/veteran/disability/age/sexual orientation/gender identity, or any other characteristic protected by law.Basic Qualifications:Must be a U.S. Citizen or National of the U.S., an alien lawfully admitted for permanent residence, or an alien authorized to work in the U.S. for this employer.Salary$25.20Actual compensation offer to candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level. The pay ratio between base pay and target incentive (if applicable) will be finalized at offer. Employee Type:PermanentUPS is committed to providing a workplace free of discrimination, harassment, and retaliation.Other Criteria: UPS is an equal opportunity employer. UPS does not discriminate on the basis of race/color/religion/sex/nationalorigin/veteran/disability/age/sexual orientation/gender identity or any other characteristic protected by law.Basic Qualifications:Must be a U.S. Citizen or National of the U.S., an alien lawfully admitted for permanent residence, or an alien authorized to work in the U.S. for this employer.Pay Range:Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $25.70/hr to $41.80/hr. Pay is based on several factors including but not limited to, market location and may vary depending on job-related knowledge, skills, and education/training and a candidate’s work experience. Hired applicants are offered annual short-term and/or long-term incentive compensation programs, subject to applicable eligibility requirements. Payments under these annual programs are not guaranteed and are dependent upon a variety of factors including, but not limited to, individual performance, business unit performance, and/or the company’s performance. The company offers the following benefits for this position, subject to applicable eligibility requirements. Medical/prescription drug coverage, Dental coverage, Vision coverage, Flexible Spending Account, Health Savings Account, Dependent Care Flexible Spending Account, Basic and Supplemental Life Insurance & Accidental Death and Dismemberment, Disability Income Protection Plan, Employee Assistance Program, 401(k) retirement program, Vacation, Paid Holidays and Personal time, Paid Sick and Family and Medical Leave time as required by law, and Discounted Employee Stock Purchase Program.

Your Role The Care management team is looking for a leader with Medi-Cal experience who can help design and lead our Medi-Cal line of business. The Senior Manager of Care Management, Medi-Cal will report to the Director of Care Management in the Population Health Department.. In this role you will be will serve as the professional leader of registered nurses within Blue Shield care management who is a good collaborator, experienced in people leadership, and will serve as a mentor and advisor to senior leadership. The selected candidate will also function as the subject matter expert on professional nursing/ care management for Medi-Cal regulations- who will represent care management in initiatives, client presentations, act as a liaison between other business units within Blue Shield to bolster care management knowledge on community resources, best practices, and promote holistic and integrated approach to medical care management..Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking,buildingand sustaining high-performing teams, getting results the right way, and fostering continuous learning.Your WorkYour WorkIn this role, you will:Establish operational objectives for department or functional area andparticipatesand leads other managers to establish group objectivesBe responsible for team, department or functional area results in terms of planning, cost and methods in collaboration with DirectorParticipate in the development and implementation of the annual budget under the direction of DirectorEnsure workflow procedures and guidelines are clearly documented and communicatedInterpret or initiate changes in guidelines/policies/proceduresProvides leadership to ensure best utilization of resources in obtaining organizational goals, regulatory compliance, adhering to corporate policies through oversight of daily operations, assessment of adequacy of staffing, and adherence to standard of social workersEnhancement or creation of care management processes in compliance with regulatory requirementsMaintenance and operationalizing of the Model of Care (MOC) for Medi-Cal SPD members, Cal-AIM, and other contracts with DHCS and CMS in close collaboration with and guidance from Director of Care ManagementResponsible for ensuring that the care management department readiness for internal and external regulatory and accreditation auditsPrimary involvement with committees, projects, initiatives, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the populationFocused on services and programs to increase quality of life and health of all membersMacro level collaboration and involvement with committees, projects, initiatives, community leaders, county social service personnel, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the populationDemonstrates a passion for leading positive change by enhancement and sustainment of an innovative care management program that advocates for patient safety by keeping informed of mandates, regulations, and best practice innovationsEnhancement and development of client health education, Advance Healthcare Planning and End of Life counseling and support and promotes participation in staff, patient, and community educationPromotion of best practice in impacting social determinants of health and homelessnessRepresent Blue Shield care management in Blue Shield sponsored community events and fairsRegular collaboration with other Blue Shield managers in care management and other business unitsMaintain daily measurement standards and outcomes for staffAn active participant in practice transformationYour Knowledge and ExperienceRequires a bachelor's degree or equivalent experienceRequires a current CA RN LicenseCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 10 years of prior relevant experience including 4 years of management experience gained as a team leader, supervisor, or project/program managerRequires health insurance/managed care experience (Commercial, Medicare, and Medi-Cal).Requires excellent communication, presentation, and procedure-writing skillsLean methodology desiredAdvanced degree preferred

Before you apply to a job, select your language preference from the options available at the top right of this page.Explore your next opportunity at a Fortune Global 500 organization. Envision innovative possibilities, experience our rewarding culture, and work with talented teams that help you become better every day. We know what it takes to lead UPS into tomorrow—people with a unique combination of skill + passion. If you have the qualities and drive to lead yourself or teams, there are roles ready to cultivate your skills and take you to the next level.Job Description:Job SummaryThis position supervises, trains, develops, and holds workgroups responsible for safety, production and attendance. He/She sets and maintains high standards for account productivity, accuracy, customer service, organization, communication, cooperation, and safety. This position provides innovative and effective leadership and cultivates a functional working relationship with all levels of personnel throughout the organization.Responsibilities:Develops and maintains good working relationships with employees, management, and customers.Facilitates training with new and current employees.Responsible to ensure that all employees adhere to safety policies and procedures at all times, operating in full compliance with department, station, corporate and local government requirements. Manages department resources to ensure maximum output, accuracy, and efficiency at all times.Establishes and promotes a positive, team-oriented work environment emphasizing employee involvement, pro-active communication, inter-departmental cooperation, and continual improvement on all levels.Implements employee personal development plans as required to ensure the continuing professional growth of department personnel.Ensures all department employees receive specific and detailed orientation, skills and safety training, appropriate materials and information, regular evaluations, and pro-active coaching to support their continued development.Ensures all employees adhere to safety policies and procedures at all times.Qualifications:Bachelor's Degree or International equivalent - PreferredAbility to lift 70 lbs./32 kgs.Availability to work flexible shift hours, up to 5 days per weekStrong oral and written communication skillsWorking knowledge of Microsoft Office Ability to work in a fast-paced warehouse environment Management experience - PreferredEmployee Type:PermanentUPS is committed to providing a workplace free of discrimination, harassment, and retaliation.Other Criteria: UPS is an equal opportunity employer. UPS does not discriminate on the basis of race/color/religion/sex/nationalorigin/veteran/disability/age/sexual orientation/gender identity or any other characteristic protected by law.Basic Qualifications:Must be a U.S. Citizen or National of the U.S., an alien lawfully admitted for permanent residence, or an alien authorized to work in the U.S. for this employer.Pay Range:Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $25.70/hr to $41.80/hr. Pay is based on several factors including but not limited to, market location and may vary depending on job-related knowledge, skills, and education/training and a candidate’s work experience. Hired applicants are offered annual short-term and/or long-term incentive compensation programs, subject to applicable eligibility requirements. Payments under these annual programs are not guaranteed and are dependent upon a variety of factors including, but not limited to, individual performance, business unit performance, and/or the company’s performance. The company offers the following benefits for this position, subject to applicable eligibility requirements. Medical/prescription drug coverage, Dental coverage, Vision coverage, Flexible Spending Account, Health Savings Account, Dependent Care Flexible Spending Account, Basic and Supplemental Life Insurance & Accidental Death and Dismemberment, Disability Income Protection Plan, Employee Assistance Program, 401(k) retirement program, Vacation, Paid Holidays and Personal time, Paid Sick and Family and Medical Leave time as required by law, and Discounted Employee Stock Purchase Program.

Job ID: 267700Location Name: CA-FSC SF Off (0174)Address: 350 Mission St, 20th Floor, San Francisco, CA 94105, United States (US)Job Type: Full TimePosition Type: RegularJob Function: FinanceRemote Eligible:Hybrid Schedule, 2 days onsiteCompany Overview:At Sephora we inspire our customers, empower our teams, and help them become the best versions of themselves. We create an environment where people are valued, and differences are celebrated. Every day, our teams across the world bring to life our purpose: to expand the way the world sees beauty by empowering the Extra Ordinary in each of us. We are united by a common goal - to reimagine the future of beauty.The Opportunity:As our Accounting Senior Manager, reporting to the Director of Accounting, you will be working closely with numerous business partners and key stakeholders and be responsible for Retail, FSC and Canada area of the business, manage the P&L and revenue recognition of business. You will also be performing analytical reviews and variance investigations as needed throughout the year, month-end reconciliations, maintaining accounting policies and procedures, and continuing the optimization of accounting and operational processes.Manage FSC, Sephora Canada, Occupancy, Credit Card and Beauty Insider in accordance with US GAAP/IFRS – This includes but is not limited to month end close activities and other day to day activities.Identify and implement key controls and mitigate risks. Monitor, maintain, and improve ongoing processes, accounting policies, and procedures across the business. Identify ways to automate processes and improve efficiency. Lead cross-functional projects to improve the level of internal control and risk management.Collaborate with cross functional teams. Work closely with numerous business partners and key stakeholders (both internally and externally) to implement process improvements, understand variances to budget, and present findings to executive management for decision making.Liaise with external auditors on audit schedules (including OAR flux analysis) and provide requested supporting documentation to ensure a smooth audit.Assist on S4HANA implementationResponsible for ad hoc projectsWe’d love to hear from you if you have …9+ years of related business experience Retail industry preferred but not a mustAdvanced skills with Excel applications (PIVOTs, SUMIFs, VLOOKUPs, macros)Experience with SAPMust demonstrate strong strategic, analytical, interpersonal, organizational, and communication skillsFamiliarity with IFRS accounting principles and financial statementsDriven, able to balance multiple priorities. Good interpersonal skills with the ability to build relationships across all levels of the organizationTech-savvySelf-motivated and resourceful#LI-MMGThe annual base salary range for this position is $151,810.00 - $169,670.00 The actual base salary offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job. Individuals employed in this position may also be eligible to earn bonuses. Sephora offers a generous benefits package to full-time employees, which includes comprehensive health, dental and vision plans; a superior 401(k) plan, various paid time off programs; employee discount/perks; life insurance; disability insurance; flexible spending accounts; and an employee referral bonus program. This job will be posted for a minimum of 5 days.While at Sephora, you’ll enjoy… The people. You will be surrounded by some of the most talented leaders and teams – people you can be proud to work with. The learning. We invest in training and developing our teams, and you will continue evolving and building your skills through personalized career plans.The culture. As a leading beauty retailer within the LVMH family, our reach is broad, and our impact is global. It is in our DNA to innovate and, at Sephora, all 40,000 passionate team members across 35 markets and 3,000+ stores, are united by a common goal - to reimagine the future of beauty.You can unleash your creativity, because we’ve got disruptive spirit. You can learn and evolve, because we empower you to be your best. You can be yourself, because you are what sets us apart. This, is the future of beauty. Reimagine your future, at Sephora.Sephora is an equal opportunity employer and values diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, ancestry, citizenship, gender, gender identity, sexual orientation, age, marital status, military/veteran status, or disability status. Sephora is committed to working with and providing reasonable accommodation to applicants with physical and mental disabilities.Sephora will consider for employment all qualified applicants with criminal histories in a manner consistent with applicable law.

The pay range per hour is $27.75 - $47.15Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at .ALL ABOUT TARGETWorking at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. ALL ABOUT GENERAL MERCHANDISEExperts of operations, process and efficiency who enable a consistent experience for our guests by ensuring product is set, merchandised and available, accurately priced and signed on the sales floor. The General Merchandise and Food Sales team leads inbound, outbound, replenishment, and promotional signing processes for all General Merchandise (GM) areas of the store. This team also leads inventory accuracy, merchandise set-up and pricing processes for all areas of the store. This team may also lead Food & Beverage and Food Service, providing a fresh and food safe experience. Experts enable efficient delivery of merchandise to our guests by owning pick, pack and ship fulfillment work. At Target, we believe in our leaders having meaningful experiences that help them build and develop skills for a career. The role of a General Merchandise Team Leader can provide you with the skills and experience of: Guest service fundamentals and experience building a guest first culture on your teamRetail business fundamentalsincluding: department sales trends, inventory management, guest shopping patterns, pricing and promotions strategies Leading a team by planning department(s) daily/weekly workload to support business priorities and deliver sales goals, with alignment from your direct leader, all while driving process improvements and enhancing workload efficiency.Leading a team of hourly team members; including skills in interviewing, developing, coaching, evaluating and retaining talent.Coaching and traininghourly team members to build a team of hourly team members with direction from your direct leaderAs a General Merchandise Team Leader, no two days are ever the same, but a typical day most likely willinclude the following responsibilities:Execute daily/weekly workload to deliver on department and store sales goals and guest engagement, including: merchandising, pricing, setting and updating merchandise salesfloor displays, sampling, promotions and price change.With guidance from your leader, educate your team on how operational procedures, such as setting up and organizing merchandise, managing product stock levels, and maintainingsales floor areas, affect inventory management, store profitability, and product availability.Help assess reporting to identify gaps in GM processes and assist to develop a plan to resolve for your direct leader to review and approve. Be an expert of operations, accuracy, process and efficiency.With your direct leader's guidance, assist with and lead the daily execution of tasks such as receiving products, restocking shelves, organizing the backroom, arranging merchandise, and putting up promotional signs for GM areas.With your direct leader’s guidance, assist and lead with the processes in inventory accuracy, merchandise set-up and maintenance, and pricing for all areas of the store.Assign daily tasks to TMs based on planned workload and guest traffic patterns, ensuring alignment with weekly and monthly business priorities set by your leader.With your direct leader’s guidance, help establish clear goals and expectations and hold team members accountable to expectations.With your direct leader’s guidance, help with efficient delivery to our guests by leading pick, pack and ship fulfillment work accurately(if applicable) and assess reporting in fulfillment to identify gaps and assist to develop a plan.Responsible for collaborating with all teams and leaders (including closing team) to identify key priorities and ensure the store is guestready in alignment with your leader’s direction.Stay informed about relevant trends and products to educate team members by relaying Target communications from available tools and resources during team connection moments.Evaluate candidates for open positions and develop a guest-centric team, as directed by your immediate leader.Modela culture of executing all best practices as outlined with team onboarding and learning; help close skill gaps through development, coaching and team interactions.Work a schedule that aligns to guest and business needs (this includes early morning, evening, overnight shifts and weekends).Support guest services such as back-up cashier, digital fulfillment processes while maintaining a compliance culture, including compliance with federal, state, and local adult beverage laws.Demonstrate inclusivity by valuing diverse voices and approaches, being authentic and respectful, and creating equitable experiences.Demonstrate a culture of ethical conduct, safety and compliance; lead and hold the team accountable to work in the same way.Lead and demonstrate a safety culture through modeling and recognizing safe behaviors, identifying and correcting hazards, holding team accountable to following safety expectations, assisting with incident response, and reporting/investigating injuries timely and accurately.Model the execution of physical security processes in order to enhance the instore security culture.Support merchandise protection strategies across the total store; including ordering, storage and application as directed by best practices.Model creating a welcoming experience by greeting guests as you and your team are completing your daily tasks.Demonstrate how to engage with guests when assistance is needed, engage with guests in a welcoming way, and help solve their specific needs.Lead by thanking guests and let them know we’re happy they chose to shop at Target.If applicable, as a key carrier, follow all safe and secure training and processes.Address all store emergency and compliance needs.All other duties based on business needsWHAT WE ARE LOOKING FORThis may be the right job for you if:You enjoy interacting and helping others - including guests that shop our store and fellow team members you work with. You thrive in a fast-moving, highly active and physically demanding role, where teamwork, flexibility, and creative problem solving are key to success. You are open to working a flexible work schedule with varying hours, days or shifts (including nights, weekends, holidays and other peak shopping times).The good news is that we have some amazing training that will help teach you everything you need to know to be a General Merchandise Team Leader. But, there are a few things you need from the get-go:High school diploma or equivalentAge18 or olderPrevious retail experience preferred, but not requiredAbility to:Lead and hold others accountableCommunicate on multiple frequency devices and operate handheld scanners, and other technology equipment as directedWork independently and as part of a teamManage workload and prioritize tasks independentlyCapability to remain focused and composed in a fast-paced environment and accomplish multiple tasks within established timeframesWelcoming and helpful attitude toward all guests and other team membersEffective communication skills We are an awesome place to work and care about our teams, so we want to make sure we are clear on a few more basics that we expect: Access all areas of the building to respond to guest or team member issuesInterpret instructions, reports and informationAccurately handle cash register operations as neededClimb up and down laddersas neededScan, handle and move merchandise efficiently and safely, including frequently lifting or moving merchandise up to 44 pounds Flexible work schedule (e.g., nights, weekends and holidays); reliable and prompt and regular attendance necessaryCapable of working in and exposure to varying temperatures, humidity, and other elements while performing certain job duties including but not limited to Drive-Up, carryout, etc.Ability to remain mobile for the duration of a scheduled shift (shift length may vary).Target will consider for employment qualified applicants with criminal histories in a manner consistent with the San Francisco and City of Los Angeles Fair Chance Ordinances.Benefits EligibilityPlease paste this url into your preferred browser to learn about benefits eligibility for this role: https://tgt.biz/BenefitsForYou_C | Pegue esta URL en su navegador preferido para obtener información sobre la elegibilidad de este puesto para recibir beneficios: https://tgt.biz/BenefitsForYou_CAmericans with Disabilities Act (ADA)Target will provide reasonable accommodations with the application process upon your request as required to comply with applicable laws. If you have a disability and require assistance in this application process, please visit your nearest Target store or reach out to Guest Services at 1-800-440-0680 for additional information.

Your Role The Facility Compliance Review (FCR)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, Seniorwill report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical documents and applying clinical criteria to establish the most appropriate level of care. This role will be focusing primarily on inpatient psych reviews for Residential Treatment and Detox. Also, you will be reviewing hospital itemized bills for a comprehensive line-by-line audit and manual claims processing on exceptions to ensure that appropriate billing practices are followed based on facility specific contract language. These exceptions may include medical necessity, DRG validation, stop loss, trauma, ER, burns, implants, NICU, transplants, hospital acquired conditions/never events and aberrant billing.Your Work In this role, you will: Perform retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEPConducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliancePrepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationand communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirementsDevelop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standardsandidentifypotential quality of care issues, service or treatment delays and intervenes or as clinically appropriateClearly communicates, is collaborative, while working effectively and efficientlyReview itemizations for coding logic using industry standards as well as CMS guidelinesTriages and prioritizes cases to meet required turn-around timesIdentifies potential quality of care issues, service or treatment delays as clinically appropriate.Clinical judgment and detailed knowledge of benefit plans used to complete review decisionsYour Knowledge and Experience Requires a bachelor's degree or equivalent experienceRequires a current California RN LicenseRequires at least 5 years of prior relevant experiencePrevious Inpatient Psych experience preferredRequires strong attention to detail to include ability to analyze claim data analyticsRequires independent motivation, strong work ethic and strong computer navigations skillsPsych claims review experience preferred

Before you apply to a job, select your language preference from the options available at the top right of this page.Explore your next opportunity at a Fortune Global 500 organization. Envision innovative possibilities, experience our rewarding culture, and work with talented teams that help you become better every day. We know what it takes to lead UPS into tomorrow—people with a unique combination of skill + passion. If you have the qualities and drive to lead yourself or teams, there are roles ready to cultivate your skills and take you to the next level.Job Description:Job SummaryThis position supervises, trains, develops, and holds workgroups responsible for safety, production and attendance. He/She sets and maintains high standards for account productivity, accuracy, customer service, organization, communication, cooperation, and safety. This position provides innovative and effective leadership and cultivates a functional working relationship with all levels of personnel throughout the organization.Responsibilities:Develops and maintains good working relationships with employees, management, and customers.Facilitates training with new and current employees.Ensures all employees adhere to safety policies and procedures at all times, operating in full compliance with department, station, corporate and local government requirements. Manages department resources to ensure maximum output, accuracy, and efficiency at all times.Establishes and promotes a positive, team-oriented work environment emphasizing employee involvement, pro-active communication, inter-departmental cooperation, and continual improvement on all levels.Implements employee personal development plans as required to ensure the continuing professional growth of department personnel.Ensures all department employees receive specific and detailed orientation, skills and safety training, appropriate materials and information, regular evaluations, and pro-active coaching to support their continued development.Ensures all employees adhere to safety policies and procedures at all times.Qualifications:Bachelor's Degree or International equivalent - PreferredAbility to lift 70 lbs./32 kgs.Availability to work flexible shift hours, up to 5 days per weekStrong oral and written communication skillsWorking knowledge of Microsoft Office Ability to work in a fast-paced warehouse environment Management experience - PreferredEmployee Type:PermanentUPS is committed to providing a workplace free of discrimination, harassment, and retaliation.Other Criteria: UPS is an equal opportunity employer. UPS does not discriminate on the basis of race/color/religion/sex/nationalorigin/veteran/disability/age/sexual orientation/gender identity or any other characteristic protected by law.Basic Qualifications:Must be a U.S. Citizen or National of the U.S., an alien lawfully admitted for permanent residence, or an alien authorized to work in the U.S. for this employer.Pay Range:Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $25.70/hr to $41.80/hr. Pay is based on several factors including but not limited to, market location and may vary depending on job-related knowledge, skills, and education/training and a candidate’s work experience. Hired applicants are offered annual short-term and/or long-term incentive compensation programs, subject to applicable eligibility requirements. Payments under these annual programs are not guaranteed and are dependent upon a variety of factors including, but not limited to, individual performance, business unit performance, and/or the company’s performance. The company offers the following benefits for this position, subject to applicable eligibility requirements. Medical/prescription drug coverage, Dental coverage, Vision coverage, Flexible Spending Account, Health Savings Account, Dependent Care Flexible Spending Account, Basic and Supplemental Life Insurance & Accidental Death and Dismemberment, Disability Income Protection Plan, Employee Assistance Program, 401(k) retirement program, Vacation, Paid Holidays and Personal time, Paid Sick and Family and Medical Leave time as required by law, and Discounted Employee Stock Purchase Program.

The pay range per hour is $28.00 - $47.60Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at .ALL ABOUT TARGETWorking at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. ALL ABOUT SERVICE & ENGAGEMENTAdvocates of guest experience who welcome, thank, and exceed guest service expectations by focusing on guest interaction and recovery. Advocates of both in-store and digital services and solutions who are knowledgeable about capabilities and features that drive adoption, usage and ultimately guest loyalty. Empowered to make shopping quick and easy for guests at the checklanes, guest services, gift registry, pick-up and drive up while ensuring exceptional quality.At Target, we believe in our leaders having meaningful experiences that help them build and develop skills for a career. The role of a Service and Engagement Team Leader can provide you with the skills and experience of: Guest service fundamentals,experience building a guest first team culture and driving loyalty programsGuest engagement; problem solving and resolution Retail business fundamentalsincluding: department sales trends, inventory management, guest shopping patterns, pricing and promotions strategiesPlanning department(s) daily/weekly workload to support business priorities and deliver service and sales goalsLeading a team of hourly team members; including skills in interviewing, developing, coaching, evaluating and retaining talentAs a Service and Engagement Team Leader, no two days are ever the same, but a typical day will most likely include the following responsibilities:Demonstrate inclusivity by valuing diverse voices and approaches, being authentic and respectful, and creating equitable experiences.Lead a team of passionate and knowledgeable Guest Advocates, Service Advocates and Front of Store Attendants who strive to exceed guest service expectations by focusing on decreasing wait time, friendly guest interactions, quality of service,resolution, driving loyalty and cleanliness standards.Lead and demonstrate a culture of executing all best practices as outlined with team onboarding and learning; help close skill gaps through development, coaching and team interactions.Understand sales goals, business reporting and guest insights to plan and execute daily/weekly workload,to deliver on store sales goals,guest engagement and troubleshoot opportunity areas as needed throughout the day.Support Target Loyalty Programs to ensure your team caneducate and promote the suite of benefits, features and offerings that reward our guest and/or enhance their shopping experience.Support your direct leaderbyfollowing-up on training completion, checking for understanding and supporting continuous education opportunities to drive proficiencies for all front of store experiences.Engage in consistent, meaningful development conversations throughout the critical touch points within the teams career path.Personalize recognition and appreciationof your team to reinforce critical guest service behaviors and promote a positive team and guest centric culture.With guidance from your direct leader, help lead a culture of accountability through clear expectations and performance management (listen, observe, recognize and coach) on critical Service and Engagement behaviors.Quickly respond to anyconcerns with aguests’ shopping experience by de-escalating the situation and ensuring your team understands and feels supported to resolve or address guest concerns and issues.Ensureyour teammembers stay up-to-date on upcoming major promotions, brand launches and events.Evaluate candidates for open positions and develop a guest-centric team.Work a schedule that aligns to guest and business needs (this includes early morning, evening, closing, overnight shifts,holidays and weekends).Support and enableteam membersto deliver pick up and drive uporders (including drive up returns and Starbucks) efficiently and accurately to digital guests, following all federal, state and local adult beverage laws. Support guest services as needed.Demonstrate a culture of ethical conductand compliance; lead team to work in the same way and hold others accountable to this commitment.Lead and demonstrate a safety culture through modeling and recognizing safe behaviors, identifying and correct hazards, holding team accountable to following safety expectations, assisting with incident response, and reporting/investigating injuries timely and accurately. Model creating a welcoming experience by greeting guests as you & your team are completing daily tasks.Demonstrate how to engage with guests when assistance is needed, engage with guests in a welcoming way, and help solve their specific needs.Lead by thanking guests and let them know we’re happy they chose to shop at Target.Model the execution of physical security processes in order to enhance the instore security culture.Support merchandise protection strategies across the total store; including ordering, storage and application as directed by best practicesIf applicable, as a key carrier, follow all safe and secure training and processes.Address all store emergency and compliance needs.All other duties based on business needsWHAT WE ARE LOOKING FORThis may be the right job for you if:You enjoy interacting and helping others - including guests that shop our store and fellow team members you work with. You thrive in a fast-moving, highly active and physically demanding role, where teamwork, flexibility, and creative problem solving are key to success. You are open to working a flexible work schedule with varying hours, days or shifts (including nights, weekends, holidays and other peak shopping times).The good news is that we have some amazing training that will help teach you everything you need to know to be a Service and Engagement Team Leader.But, there are a few skills you should have from the get-go:High school diploma or equivalentMust be at least 18 years of age or olderPrevious retail experience preferred, but not requiredLead and hold others accountableAbility to communicate on multiple frequency devices and operate handheld scanners, and other technology equipment as directed.Work independently and as part of a teamManage workload and prioritize tasks independently and with a teamWelcoming and helpful attitudeEffective communication skills Capability to remain focused and composed in a fast-paced environment and accomplish multiple tasks within established timeframesWe are an awesome place to work and care about our teams, so we want to make sure we are clear on a few more basics that we expect:Access all areas of the building to respond to guest or team member issuesInterpret instructions, reports and informationAccurately handle cash register operations, cash transactions, and oversee cash office processes as needed Scan, handle and move merchandise efficiently and safely, including frequently lifting or moving merchandise up to 10 pounds and occasionally lifting or moving merchandise up to 44 pounds without additional assistance from others Climb up and down ladders as needed Flexible work schedule (e.g., nights, weekends and holidays) and reliable and prompt attendance necessaryCapable of working in and exposure to varying temperatures, humidity, and other elements while performing certain job duties including but not limited to Drive-Up, carryout, etc. as neededAbility to remain mobile for the duration of a scheduled shift (shift length may vary).Target will consider for employment qualified applicants with criminal histories in a manner consistent with the San Francisco and City of Los Angeles Fair Chance Ordinances.Benefits EligibilityPlease paste this url into your preferred browser to learn about benefits eligibility for this role: https://tgt.biz/BenefitsForYou_C | Pegue esta URL en su navegador preferido para obtener información sobre la elegibilidad de este puesto para recibir beneficios: https://tgt.biz/BenefitsForYou_CAmericans with Disabilities Act (ADA)Target will provide reasonable accommodations with the application process upon your request as required to comply with applicable laws. If you have a disability and require assistance in this application process, please visit your nearest Target store or reach out to Guest Services at 1-800-440-0680 for additional information.

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 criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.Your Work In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as neededGather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationProvide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteriaWork with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed ManagerRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and Experience Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least five (5) years of prior experience in healthcare related fieldThree (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment requiredStrong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed

Starting Hourly Rate / Salario por Hora Inicial: $20.25 USD per hourALL ABOUT TARGETWorking at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. ALL ABOUT HUMAN RESOURCESYou are a team that champions change, proactively removes roadblocks and builds diverse and inclusive talent strategies to deliver on our guest centric mission. You are part ofa Human Resource (HR)team who are committed to supporting teams and leaders to build a sales force that is passionate about exceeding guests’expectations and a place where teams love to work. At Target, we believe in our team members having meaningful experiences that help them build and develop skills for a career. The role of a Human Resources Expert can provide you with the: Knowledge of federal,state and local employment lawsExperience using basic Microsoft Office Suite computer and workforce management programsAbility to effectively use scheduling software As a Human Resources Expert, no two days are ever the same, but a typical day will most likely include the following responsibilities: Work with your HR leader to anticipate and address specific talent and staffing needs for each area of the business; this includes understanding guests’ needs and ensuring the right mix of experience, and enthusiasm to deliver on the in-store and digital shopping experiences.Lead focused recruiting efforts to help store leaders find and hire candidates with the right skills and experiences to best serve their guest.Support team member and leader training needs and be an advocate for continuous learning.Be an expert resource for scheduling systems and pay practices.Be approachable and available by listening to team members and collaborating with appropriate leaders to take action as needed.Deliver on all Human Resources processes and programs to maximize team member engagement and minimize business disruption.Support your leader in following company compliancepolicies that mitigate risk to the team member experience.Create a welcoming experience by greeting guests as you are completing your daily tasks.When a guest needs assistance, engage with guests in a welcoming way, to help solve their specific needs.Thank guests and let them know we’re happy they chose to shop at Target.Demonstrate a culture of ethical conduct, safety and compliance.Work in a safe manner at all times;comply with all safety policies,best practices, and training; report hazards and correct where possible.All other duties based on business needsWHAT WE ARE LOOKING FORThis may be the right job for you if:You enjoy interacting and helping others - including guests that shop our store and fellow team members you work with. You thrive in a fast-moving, highly active and physically demanding role, where teamwork, flexibility, and creative problem solving are key to success. You are open to working a flexible work schedule with varying hours, days or shifts (including nights, weekends, holidays and other peak shopping times).The good news is that we have some amazing training that will help teach you everything you need to know to be a Human Resources Expert. But there are a few skills you should have from the get-go:Welcoming and helpful attitude toward all guests and other team membersAbility to communicate on multiple frequency devices and operate handheld scanners, and other technology equipment as directed.Effective communication skillsWork both independently and with a teamResolve guest questions quickly on the spotAttention to detail and follow a multi-step processesCapability to remain focused and composed in a fast-paced environment and accomplish multiple tasks within established timeframesWe are an awesome place to work and care about our teams, so we want to make sure we are clear on a few more basics that we expect:Accurately handle cash register operations as needed.Lift product up to 10 pounds regularly without additional assistance from others.Capable of working in and exposure to varying temperatures, humidity, and other elements while performing certain job duties including but not limited to Drive-Up, carryout, etc.Ability to remain mobile for the duration of a scheduled shift (shift length may vary).Flexible work schedule (e.g., nights, weekends and holidays); reliable and prompt attendance necessaryFind competitive benefits from financial and education to well-being and beyond at .Target will consider for employment qualified applicants with criminal histories in a manner consistent with the San Francisco and City of Los Angeles Fair Chance Ordinances.Benefits EligibilityPlease paste this url into your preferred browser to learn about benefits eligibility for this role: https://tgt.biz/BenefitsForYou_A | Pegue esta URL en su navegador preferido para obtener información sobre la elegibilidad de este puesto para recibir beneficios: https://tgt.biz/BenefitsForYou_AAmericans with Disabilities Act (ADA)Target will provide reasonable accommodations with the application process upon your request as required to comply with applicable laws. If you have a disability and require assistance in this application process, please visit your nearest Target store or reach out to Guest Services at 1-800-440-0680 for additional information.

Your Role Reporting to the Manager, Care Management- Behavioral Health, the Behavioral Health Care Management Clinician, Seniorhelps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs. The Behavioral Health Care Manager will offer support in assessing members’ emotional and psychological well-being and providing resource coordination, crisis intervention, substance abuse, and with any behavioral or mental health referrals. The Behavioral Health Care Management Clinician, Senior will be available to physicians and nurse care managers as a consultant for patients with complex psychosocial needs. The position requires an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages.Your Work In this role, you will: Collaborate with case managers and other team members tocomplete member assessments related to social and resource needs tosupportmemberaccess to servicesCollaborate with service coordination staff and act as liaison to ensure a timely and accurate response to member needsCollaborate with providers to support members’ treatment plan and care needsRecognize the client’s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamAssessmembers health behaviors, cultural influences and clients belief/value systemand evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersEfficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness.Maintains an active workload in accordance with National Care Manager performance standards.Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases.Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independentlyAs a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.)Your Knowledge and Experience Current unrestricted CA License (LCSW, LMFT, LPCC, Registered Nurse (RN), or PsyD by the Board of Behavioral Health Sciences requiredAdvanced degree commensurate with field is preferredRequires at least five (5) years of prior relevant experience, including three (3) years of experience in behavioral health.Certified Case Manager preferredExperience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housingConsiderable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatmentProficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint

Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare & Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives.This individual will play a key role as part of the Utilization Management team in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership. The Director, Medicare & Medi-Cal Utilization Management role will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.Your Work In this role, you will: Manages and monitors prior authorization and concurrent review to ensure that the patient is getting the right care in a timely and cost-effective way.Leading development of UM strategy by leveraging the use of data/analytics to inform and technology solutions to streamline operational efficiencies while also building a cost-benefit methodology to rationalize decisions on UM reviews to be performed based upon staffing costs, productivity, and projected medical cost savings.Provides analysis and reports of significant utilization trends, patterns, and resource allocation.Partners with physicians and others to develop improved utilization of effective and appropriate services.Establishing and measuring productivity metrics to support workforce planning methodology and rationalization of services required to perform UM reviews.Reviewing and reporting out on Utilization Review (UR) trending for Medicare and Medi-Cal membership.Ensuring alignment of the authorization strategy with clinical policy, payment integrity, and network development strategies to optimize quality and cost of care.Responsible for managing strategic projects and supporting operations initiatives.Leading operational implementation of transformation changes (organizational management, process implementation, technology adoption).Responsible for operational teams' performance, resource management, continuous improvement, and training.Responsible for operational audit readiness, ensuring adequate processes and internal audit measures in place and maintained quarterly.Ensuring all operational processes are meeting regulatory and accreditation requirements.Fosters a culture of process excellence, BSC leadership principles, and a great place to work environment.Occasional business travel required.Your Knowledge and Experience Requires current CA RN LicenseBachelor’s of Science in Nursing or advanced degree preferredMaster’s degree or equivalent experience preferredMinimum of 10 years of Utilization Management or relevant experience, including 6 years of management experienceMinimum of 5 years of progressive leadership in Utilization Management operationsHealth plan or similar health care organization structure experience requiredSuccessful track record in driving organizational change managementExcellent relationship and consensus-building skills required

Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective, concurrent, retrospective utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Behavioral Health Utilization Management, Consultant (Lead), will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will support the clinicians with daily operations, provide coaching, and serve as the subject matter expert for the BH UM team as they conduct clinical reviews of mental health and substance use authorization requests at various levels of care for medical necessity.Your WorkIn this role, you will:Facilitate communication between leadership, Medical Directors, and non-clinical leads to address line staff questions and issues; escalate matters to management with recommendations or consultation as neededLead onboarding/training of incoming staff, provide proactive and guided support through the onboarding processMaintain and gain knowledge of behavioral health utilization management through team and departmental expansion as neededAct as subject matter expert to review and evaluate the effectiveness of operational workflows to identify problems and develop improvements, modifications, and enhancementsDevelop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staffAssist with audit readiness in collaboration with internal BSC partnersPerform advanced or complicated prior authorization and concurrent utilization reviews and first level determinations for members using non-profit association guidelines ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for oversight and necessity determinationIdentify process and control improvement opportunities and provide recommendations that help improve the effectiveness, efficiency and/or economic value of a control or processProvide guidance, coaching and training on internal behavioral health utilization management processes to other employees across the company as appropriateLead, manage, and execute other special projects and team initiatives as assignedLead team huddles/meetings to support processes and collaboration of team membersSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least seven (7) years of prior experience in healthcare related fieldExperience operating in a lead role or equivalent leadership training is preferredFive (5) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredDeep knowledge of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay clinical against nonprofit association guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed

Your Role The Care Managementteam 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 Case Management – Nurse, Senior will report to the Manager of Care Management. In this role you will play a pivotal role in assessing member needs, providing clinical education, as well as care coordinationwith providers, medical groups, and community resources. You will be responsible for managing and coordinating patient care, ensuring that our members receive the highest quality of care and services. Care Managers perform care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.Your Work In this role, you will: Determine appropriateness of referral for CM services, mental health, and social servicesAssess members health behaviors, cultural influences and clients belief/value system. Evaluate all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. Adjust plans or create contingency plans as necessaryIdentify appropriate programs and services that align with member needs and preferencesInitiate timely Individualized Care Plans (ICP) based on Health Risk Assessment (HRA) completion, participation in and documentation of Interdisciplinary meetings (ICT), assisting in transitions of care across all agesProvide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental casesResearch opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipate potential barriers while establishing realistic goals to ensure success for the member, providers, and BSCDetermine realistic goals and objectives and provide appropriate alternatives. Actively soliciting client’s involvementRecognize need for contingency plans throughout the healthcare processProvide education and support to members and their families regarding health conditions, treatment options, and community resourcesFollow up with members as appropriate to ensure they have successfully connected with recommended programs and servicesYour Knowledge and Experience Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hireBachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires 5 years experience in nursing, healthcare, or related field A minimum of 3 years managed care experience in inpatient, outpatient, or managed care environment preferredHealth insurance/managed care experience preferredTransitions of care experience preferredStrong knowledge of healthcare delivery systems, managed care principles, and care coordinationExcellent communication skills

Your Role The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events . The Manager, Utilization Management Nurse Management will report to the Senior Manager, Facility Compliance Review . In this role you will be responsible for several direct reports, be a resource for problem solving issues, training and updating documentation as needed. You will work to enhance the department’s operations with efficiency and attention to detail/quality.Your Work In this role, you will: Establish operational objectives for department or functional area and participate with other managers to establish group objectivesBe responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr ManagerDevelop and maintain FCR workflows, protocols, and policies to ensure efficient and effective care coordinationEnsure workflow procedures and guidelines are clearly documented and communicatedInterpret or initiate changes in guidelines/policies/proceduresMonitor and evaluate the performance of the FCR team and implement improvement strategies as neededKeeps team focused on specific and measurable performance goals and monitors performance against clear standards.Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomesProvide Ensure the delivery of high-quality, patient-centered care through the management of chronic disease, complex case management, and discharge planningOther duties as assigned by Sr ManagerYour Knowledge and Experience Requires a current CA RN LicenseBachelors of Science in Nursing or advanced degree preferred.Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program managerA minimum of 3+ year experience in inpatient or managed care environment preferredExcellent communication, interpersonal, and negotiation skillsHas functional expertise within the area of responsibility.Knowledge of NCQA requirements preferredAbility to analyze data and create reports to guide decision-making and process improvements

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional Registered Nurse Case Manager will report to the FEP Care Management Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needsYour WorkIn this role, you will:Coordinate care for lower level of care such Skilled Nursing Facility, Home Health, Home Infusion, Acute Rehab, Long-term Acute Care Hospital, Hospice, and other community program as appropriatePerform effective discharge planning and collaborate with member’s support system and health care professionals involved in the continuum of careProvides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease). Outreach to members with HEDIS Care Gaps to assist with closureApply detailed knowledge of FEP PPO and Blue Shield of California's established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each caseResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying withcontract for each appropriate plan typeProvide Referrals to QualityManagement (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamDesign appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomesInitiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsMust be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentationYour Knowledge and ExperienceRequires a current CA RN License.Bachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 5 years of prior experience in nursing, healthcare or related field3+ years managed care experience preferred.Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources preferredBehavioral health, oncology, or OB/NICU/pediatrics experience preferredStrong electronic clinical documentation skills, independent problem identification and resolution skillsKnowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirableCompetent understanding of NCQA and federal regulatory requirementsDemonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-makingDemonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care

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 criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Experienced, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.Your WorkIn this role, you will:Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as neededGather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationProvide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteriaWork with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed ManagerRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least three (3) years of prior experience in healthcare related fieldOne (1) year conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredStrong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed