Occupational Therapist Join our team as an Occupational Therapist, where you will help individuals regain independence and improve their quality of life through customized therapeutic programs. This role is ideal for professionals passionate about empowering patients to overcome physical, emotional, or developmental challenges. Key Responsibilities: Evaluate patients' conditions and develop individualized treatment plans to address their needs.Plan and implement rehabilitative programs to improve daily living, vocational, and homemaking skills.Utilize therapeutic techniques, adapt environments, and modify tasks to overcome barriers to independence.Collaborate with patients, families, and other healthcare professionals to optimize care outcomes.Educate patients and caregivers on exercises, therapies, and strategies for continued progress outside the clinical setting.Document patient progress and adjust treatment plans as necessary. Work Environment: Work in diverse settings such as hospitals, outpatient clinics, schools, or patients' homes.Engage in a dynamic environment that may require standing for extended periods or assisting clients with mobility challenges. Benefits: Competitive salary with opportunities for professional growth.Comprehensive health, dental, and vision insurance plans.Retirement savings plan with employer contributions.Access to continuing education programs and certifications. Equal Opportunity Employer: We are committed to fostering a diverse and inclusive workplace where all employees feel valued and supported in their professional journey. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Medical Director, National Accounts position is dedicated to supporting the promotion of growth and increased market share of the National Accounts and the Administrative Services Only (ASO) business. This includes strategic clinical and healthcare cost management guidance for the existing Blue Shield of CA book of business. This position will report directly to the VP, CMO, Commercial Markets. This position provides clinical direction to the sales team and sales processes and interacts directly with employers and consultants. This role will be at the center of driving strategy for how to reduce cost of care, while providing client advisory services, increasing engagement, and improving the quality of care & population health for our employers’ membership.Your Work In this role, you will: Lead client and producer facing activities including finalist presentations and account services meetings, broker and consultant meetings, meetings with Mercer, WTW, Aon, etc. Actively participate in and guide the preparations and the actual client meetings. Other activities include interpreting clinical data for employers at regular or pre-determined intervals, reviewing cost/spending trends, making recommendations on improving member engagement and population health. You will work diligently both internally and externally to develop, refine, and expertly communicate the BSC Clinical Value Proposition.Work collaboratively with other Healthcare Solutions and BSC staff to quickly resolve client service issues, with particular emphasis on clinical issues. Be available to talk with key account members about their issues and the solutions.Act as a strategic thought-partner for key clients (e.g. UC, Stanford, CalPERS) who want best-in-class medical, health and wellness programs.Responsible for the planning, development, and leading the delivery of Healthcare Solutions related materials to clients, producers and business associations that describe and explain the operational details and value of Healthcare Solutions capabilities, services and programs. Includes working with the Health Data Reporting teams to analyze data trends and develop external customer reports.Support other ASO Line of Business activities such as: business planning, business development, and designing and implementing innovations to address market needs.Your Knowledge and Experience Medical Degree (M.D./D.O.)Completed residency preferably in adult based primary care specialty (e.g. internal medicine, family practice)Active, unrestricted California State Medical LicenseMinimum 10 years managed care experience requiredAt least five years clinical experience requiredExperience with California managed care marketplace is requiredPrevious experience in national, complex account management support is requiredExperience supporting Administrative Services Only (ASO) lines of business is preferredPrevious experience in a similar sales role preferredPrior experience as a people manager preferredExcellent verbal and written communication skills, including ability to speak comfortably and extemporaneously to diverse audiencesAbility to explain program, clinical, operational, and quantitative information in a business-like, clear, coherent, and comprehensible wayStrong quantitative and analytic skills working with claims, operational, and clinical data and reportsExcellent interpersonal communication skills, including active listening, self-management and awareness, emotional intelligence, and ability to flex interpersonal style situationalDemonstrated ability to model a collaborative approach with internal and external stakeholdersStrong negotiation and creative problem-solving skillsStrong skills with Microsoft Office Suite, including PowerPoint, Excel, Word and Outlook

Overview: Licensed Clinic Director -Care Coordination ProgramTherapy + Care Coordination: The Best of Both Worlds!We’re looking for a licensed therapist to support our innovative new care coordination program! This opportunity empowers you to practice at the top of your license, while giving you the chance to branch out into care coordination duties designed to standardize your hours and grow your career. All this plus truly flexible scheduling, amazing benefits, and the ability to make a huge difference in the lives of seniors!Incentive OpportunitiesFor some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The OpportunityWe are hiring a Clinic Director to work with the residents in one our senior living facilities. You will play a pivotal role in enhancing the lives of seniors across all levels of care, including Independent Living, Assisted Living, Memory Care, and Skilled Nursing. Your expertise and dedication will contribute to promoting independence, functional ability, and overall well-being in our residents’ lives.As the Clinic Director, you will be responsible for the oversight of patient care in an assigned community or communities in accordance with Federal, State, and Local regulations. The Clinic Director is responsible for providing services (Therapy and/or Wellness) and operational support to the rehabilitation service teams for implementation of company-wide policies, clinical programs, and quality initiatives to optimize each patients functional well-being and satisfaction. As the Clinic Director, you may be responsible for advising treatment planning and therapeutic interventions in an interdisciplinary environment consistent with the positions qualifications, professional practices, and ethical standards.As a therapist, you will be responsible for providing a full range of therapy services including assessment, treatment planning, and therapeutic interventions in an interdisciplinary environment consistent with the position's qualifications, professional practices, and ethical standards. You will also contribute to program development, quality improvement, and problem-solving in accordance with company-wide policies and clinical initiatives, to optimize each patient’s functional well-being and satisfaction.What You’ll NeedDegree from an accredited OT, PT, COTA, PTA, or SLP programActive ASHA Certification Required for SLP candidatesCurrent state licensure in OT, PT, COTA, PTA or SLPExcellent verbal, written and interpersonal communication skillsA results-oriented mindset with strong critical thinking and problem-solving skillsA tech-savvy skillset with the ability to learn quicklyA sense of professional curiosity, with a desire to learn new things, and to find/recommend solutions to problemsA minimum of one year management experience preferredWhat You’ll Find at EmpowerMeFull-Time Employees401(k) with Opportunity for Matching Funds Full Benefits Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffHSA and FSA Life and Disability Insurance Employee Assistance Program Career Advancement and Cross Training Opportunities Recognition Programs Fun at work, a team you will love ,and a culture you can stand behind!Part-Time EmployeesVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffEmployee Assistance ProgramCareer Advancement and Cross Training OpportunitiesRecognition ProgramsFun at work, a team you will love, and a culture you can stand behind!Find a job you love to do that leaves room for the life you want to live. Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $33.00 - $60.00 per hour

Physical Therapist - OtherWe are seeking a versatile and skilled Physical Therapist to join our team. In this role, you will provide specialized physical therapy services tailored to unique patient populations or settings, helping individuals improve mobility, manage pain, and regain independence.Key Responsibilities:Evaluate patients to determine their physical therapy needs and create individualized treatment plans.Implement therapeutic exercises, manual therapy techniques, and other interventions to address patients' specific conditions.Educate patients and caregivers on exercises, lifestyle changes, and techniques to promote recovery and prevent future injuries.Collaborate with other healthcare professionals to ensure comprehensive patient care.Document patient progress and adjust treatment plans as necessary to achieve optimal outcomes.Adapt therapy approaches based on the unique requirements of the setting or patient population.Work Environment:Provide care in diverse settings such as home health, schools, community programs, or specialized facilities.Work in a dynamic environment requiring adaptability and innovative problem-solving skills.Collaborate with multidisciplinary teams to deliver holistic care tailored to individual needs.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through specialized training and certifications.A supportive work environment focused on collaboration and innovation in patient care.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Sr. Medical Director, Medical Policy will report to the Chief Medical Officer. In this role you will be accountable for ensuring that all medical, medication, and payment policy initiatives are in aligned with the scientific evidence and professional guidelines. You will lead a team that delivers medical policy that adapts to new clinical innovations and supports medical payment operations, and training for staff in the accurate application of medical, medication, and payment policy, pricing, and coding. In addition to chairing the BSC Pharmacy & Therapeutics, Medical and Payment Policy Committees, you will provide clinical leadership for all evidence-based medicine functions and partner closely with leaders of other business functions to develop strategies to ensure that Blue Shield members are receiving appropriate quality care.Your WorkIn this role, you will:Provide clinical thought leadership for the design and implementation of clinical policy innovation initiatives such as Coverage with Evidence Development, and the development of robust and efficient approaches to developing policies for emerging classes of technology like molecular diagnostics and mobile/digital personal health devicesChair the Medical Policy and Pharmacy and Therapeutics CommitteesProvide clinical leadership and medical consultation for the Blue Shield of California (BSC) medication management process, including working closely with the Pharmacy Services team to promote safe, effective, and cost-efficientProvide medical expertise in daily clinical rounds for drug authorization case reviewChair the Payment Policy Committee and provide clinical leadership for the BSC Payment Policy committee, overseeing and advising about payment policies and tactical approaches to ensure accurate coding of servicesConsult with BSC legal team to support fraud and abuse investigations, provider arbitrations, regulatory inquiries and issues, and litigation related to clinical policy, coding, or pricing issuesAct as BSC’s representative to the Blue Cross Blue Shield Association (BCBSA) Technology Assessment process and the Medical Policy PanelParticipate on the California Technology Assessment Forum and other related activitiesPartner with Network Management and Provider Partnership teams by providing subject matter expertise for contract and benefits coding decisions, including mandated benefits, provider contract language, provider DOFRs (division of financial responsibilities), and providing clinical perspective to resolve issues with BSC providers related to clinical policy, coding, and billing.Provide subject matter expertise for pricing of new, zero-dollar, and other exceptional claimsPresent at IPA/MG and Provider education seminars regarding medical, medication and payment policy Your Knowledge and ExperienceMinimum of 2 years of previous medical leadership experienceMinimum of 5 years of direct patient care experience post residencyMinimum of 8 years of experience developing evidence-based guidelines, medical policies or performing systematic reviews of the medical literatureMedical degree (M.D./D.O.) required. Master’s degree in epidemiology, health services or related degree is preferredCompleted residency preferably in adult based primary care specialty (e.g. Internal Medicine, Family Practice)Maintain active, unrestricted California State Medical License required; Maintain active, unrestricted Medical License in all additional assigned states requiredMaintain Board Certification in one of ABMS, ABOS, or AOA recognized specialty required (preferably Internal Medicine or Family Practice)Has mastery level knowledge and skills within a specific technical or professional discipline with broad understanding of other areas within the job functionOutstanding verbal and written communication skillsAbility to lead through influence in a matrixed organizationExperience performing utilization management reviews is preferredExperience in a health plan or managed care organization is preferred#LI-JS3

Overview: Grow your career! At EmpowerMe Wellness, you’ll find opportunities for promotion, continuingeducation, andgreat benefits, all while making a real difference in the life of seniors. Our results are in our successstories – comewrite yours with us. Join our team today!Who We AreEmpowerMe Wellness – is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated on-site therapy, pharmacy services, primary care, and more at senior living communities nationwide. Our experienced team of more than 3,000 clinicians and professionals provide personalized health and wellness solutions for seniors in more than 35 states. To learn more about us, visit empowerme.com. Responsibilities: Who You AreYou’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a job; -you seek a calling – a mission you can feel great about. And you want a support system to assure your career ascends to the highest of heights.How You Can HelpWe are hiring a Clinic Director to work with the residents in one our senior living facilities. You will play a pivotal role in enhancing the lives of seniors across all levels of care, including Independent Living, Assisted Living, Memory Care, and Skilled Nursing. Your expertise and dedication will contribute to promoting independence, functional ability, and overall well-being in our residents’ lives.The Impact You Can MakeAs a therapist, you will be responsible for providing a full range of therapy services including assessment, treatment planning, and therapeutic interventions in an interdisciplinary environment consistent with the position's qualifications, professional practices, and ethical standards. You will also contribute to program development, quality improvement, and problem-solving in accordance with company-wide policies and clinical initiatives, to optimize each patient’s functional well-being and satisfaction.As the Clinic Director, you will be responsible for the oversight of patient care in an assigned community or communities in accordance with Federal, State, and Local regulations. The Clinic Director is responsible for providing services (Therapy and/or Wellness) and operational support to the rehabilitation service teams for implementation of company-wide policies, clinical programs, and quality initiatives to optimize each patients functional well-being and satisfaction. As the Clinic Director, you may be responsible for advising treatment planning and therapeutic interventions in an interdisciplinary environment consistent with the positions qualifications, professional practices, and ethical standards.What You’ll NeedDegree from an accredited OT, PT, COTA, PTA, or SLP programActive ASHA Certification Required for SLP candidatesCurrent state licensure in OT, PT, COTA, PTA or SLPExcellent verbal, written and interpersonal communication skillsA results-oriented mindset with strong critical thinking and problem-solving skillsA tech-savvy skillset with the ability to learn quicklyA sense of professional curiosity, with a desire to learn new things, and to find/recommend solutions to problemsA minimum of one year management experience preferredWhat You’ll Find at EmpowerMeFull-Time Employees401(k) with Opportunity for Matching Funds Full Benefits Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffHSA and FSA Life and Disability Insurance Employee Assistance Program Career Advancement and Cross Training Opportunities Recognition Programs Fun at work, a team you will love ,and a culture you can stand behind!Part-Time EmployeesVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffEmployee Assistance ProgramCareer Advancement and Cross Training OpportunitiesRecognition ProgramsFun at work, a team you will love, and a culture you can stand behind!Find a job you love to do that leaves room for the life you want to live. Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $47.00 - $63.00 per hour

Physical Therapist - Skilled Nursing Facility (SNF)If you are passionate about helping patients regain mobility and independence, consider joining our team as a Physical Therapist in a skilled nursing facility. You will design and implement rehabilitation programs tailored to residents' unique needs.Key Responsibilities:Assess residents' physical conditions and develop individualized treatment plans.Utilize therapeutic exercises, manual therapy techniques, and equipment to aid recovery.Educate residents on maintaining physical health and preventing future injuries.Collaborate with other healthcare professionals to ensure comprehensive care plans are executed effectively.Monitor progress and adjust therapy programs as needed for optimal outcomes.Work Environment:Provide care in skilled nursing facilities focused on long-term patient recovery.Work within a multidisciplinary team dedicated to enhancing residents' quality of life.Benefits:A competitive compensation package with benefits included.A focus on professional development through training programs and certifications.A supportive workplace culture that emphasizes teamwork and innovation.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment, planning, implementation, and evaluation of the Member’s Care Plan. The Licensed Clinician, Senior will report to the Manager, Behavioral Health Utilization Management. In this role you will be working with both the Utilization and Care Management teams, who provide utilization management, telephonic triage and care management assistance to members requesting access to Applied Behavioral Analysis (ABA) benefit. This role has a primary function of utilization management for our members seeking Behavioral Health Treatment (BHT).Your Work In this role, you will: Perform prospective utilization reviews and first level determination for members using BSC evidenced based guidelines, policies and/or nationally recognized clinal criteriaReview Functional Behavioral Assessments (FBA) and Board Certified Behavior Analyst (BCBA) Assessments submitted by providers for adherence to BACB “best practice” guidelinesGather clinical information and apply the appropriate clinical criteria/guideline, policy, and clinical judgment to render coverage determination/recommendation; prepare and present cases to Medical Director (MD) for medical director oversight and necessitydeterminationDevelop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriateAct as a liaison with caregivers, providers, and the health care community to provide information to regarding community treatment resources, mental health managed care programs, company policies and procedures, and medical necessity criteriaSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsRecognize 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 teamYour Knowledge and Experience Master’s degree in psychology or a related fieldPossesses an active BCBA certificationAt least 5 years of experience as a BCBA • Expert knowledge of Applied Behavior Analysis and Autism Spectrum DisordersConsiderable knowledge of Managed Care and the different lines of businessDemonstrated ability to deliver training to varied audiences and conduct effective meetingsExperience in a managed health care environment with regards to BHT servicesAbility to identify problems and works towards problem resolution independently, seeking guidance as neededAbility to represent the health plan in a professional and knowledgeable fashionAbility to express ideas clearly in both written and oral communicationsAbility to develop, organize, analyze, and implement processes and proceduresProficiency with Microsoft applications including Word, Excel, Outlook, and TeamsEffective interpersonal skills

Overview: Grow your career! At EmpowerMe Wellness, you’ll find opportunities for promotion, continuingeducation, andgreat benefits, all while making a real difference in the life of seniors. Our results are in our successstories – comewrite yours with us. Join our team today!Who We AreEmpowerMe Wellness – is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated on-site therapy, pharmacy services, primary care, and more at senior living communities nationwide. Our experienced team of more than 3,000 clinicians and professionals provide personalized health and wellness solutions for seniors in more than 35 states. To learn more about us, visit empowerme.com. Responsibilities: Who You AreYou’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a job; -you seek a calling – a mission you can feel great about. And you want a support system to assure your career ascends to the highest of heights.How You Can HelpWe are hiring a Clinic Director to work with the residents in one our senior living facilities. You will play a pivotal role in enhancing the lives of seniors across all levels of care, including Independent Living, Assisted Living, Memory Care, and Skilled Nursing. Your expertise and dedication will contribute to promoting independence, functional ability, and overall well-being in our residents’ lives.The Impact You Can MakeAs a therapist, you will be responsible for providing a full range of therapy services including assessment, treatment planning, and therapeutic interventions in an interdisciplinary environment consistent with the position's qualifications, professional practices, and ethical standards. You will also contribute to program development, quality improvement, and problem-solving in accordance with company-wide policies and clinical initiatives, to optimize each patient’s functional well-being and satisfaction.As the Clinic Director, you will be responsible for the oversight of patient care in an assigned community or communities in accordance with Federal, State, and Local regulations. The Clinic Director is responsible for providing services (Therapy and/or Wellness) and operational support to the rehabilitation service teams for implementation of company-wide policies, clinical programs, and quality initiatives to optimize each patients functional well-being and satisfaction. As the Clinic Director, you may be responsible for advising treatment planning and therapeutic interventions in an interdisciplinary environment consistent with the positions qualifications, professional practices, and ethical standards.What You’ll NeedDegree from an accredited OT, PT, COTA, PTA, or SLP programActive ASHA Certification Required for SLP candidatesCurrent state licensure in OT, PT, COTA, PTA or SLPExcellent verbal, written and interpersonal communication skillsA results-oriented mindset with strong critical thinking and problem-solving skillsA tech-savvy skillset with the ability to learn quicklyA sense of professional curiosity, with a desire to learn new things, and to find/recommend solutions to problemsA minimum of one year management experience preferredWhat You’ll Find at EmpowerMeFull-Time Employees401(k) with Opportunity for Matching Funds Full Benefits Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffHSA and FSA Life and Disability Insurance Employee Assistance Program Career Advancement and Cross Training Opportunities Recognition Programs Fun at work, a team you will love ,and a culture you can stand behind!Part-Time EmployeesVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffEmployee Assistance ProgramCareer Advancement and Cross Training OpportunitiesRecognition ProgramsFun at work, a team you will love, and a culture you can stand behind!Find a job you love to do that leaves room for the life you want to live. Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $53.00 - $65.00 per hour

Occupational Therapist - Inpatient We are seeking a dedicated Occupational Therapist to join our inpatient care team. In this role, you will help patients regain independence and improve their ability to perform daily activities following injuries, illnesses, or surgeries. Key Responsibilities: Evaluate patients' physical, cognitive, and emotional abilities to develop individualized treatment plans.Design and implement therapeutic interventions to enhance patients' daily living skills and independence.Collaborate with interdisciplinary teams, including physicians and nurses, to ensure comprehensive care plans.Educate patients and families on strategies to maintain progress after discharge.Document patient progress and adjust treatment plans as necessary. Work Environment: The role is based in hospital inpatient units where occupational therapists assist patients recovering from surgeries, strokes, or other acute conditions.This position may require standing for extended periods and assisting patients with mobility or task modifications. Benefits: A competitive salary with opportunities for career growth within inpatient rehabilitation settings.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance skills as an occupational therapist. Equal Opportunity Employer: Your expertise is valued here. We are committed to fostering an inclusive environment where all employees can thrive professionally while delivering exceptional care to our patients during their recovery journeys. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Behavioral Health Teamis responsible the coordination of care and assistance in finding providers for members in need. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor, Operations -Behavioral Health . In this role you will be for supporting clinical staff day-to-day operations.Your Work In this role, you will: Work in a production-based environment with defined production and quality metrics.Process Faxed /Web Portal /Phoned in Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.The CSC will oversee designated queues and workstreams, with standardized reports to detect and address member needs.Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider networksData entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.Serves as an initial point of contact for providers and/or members in the behavioral health management process by telephone or correspondence.Assists with system letters, requests for information and data entry.Provides administrative/clerical support to Behavioral Health management.Your Knowledge and Experience Requires a high school diploma or equivalentRequires at least 3 years of prior relevant experienceDesired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.

Overview: Physical Therapist Assistant (PTA) - SNFBonus Opportunity This position includes a $2,500 sign on bonus. Your Schedule, Your Way!What sets EmpowerMe Wellness apart from other therapy providers It’s simple: we offer truly flexible scheduling. Need to be home for family or other obligations No problem! You can easily adjust your day to fit your needs all while making a huge difference in the lives of seniors!Incentive OpportunitiesFor some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The OpportunityWe are hiring a Physical Therapist (PT)to join our team and work with the residents of askilled nursing care facility (SNF) that may offer rehab-to-home or long-term care settings. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part A. As a PT, you will be responsible for:Providing physical therapy and wellness services for older adultsConducting assessments, treatment plannings, and therapeutic interventions in an interdisciplinary environmentMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesContributing to program development, quality improvement, and problem-solvingOptimizing each patient’s functional well-being and satisfactionYour ScheduleWhile our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle!Our Amazing BenefitsAll Employees Get:Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind!401(k) Eligibility with Opportunity for Matching FundsAmazing Career Advancement and Cross Training OpportunitiesRecognition ProgramsEmployee Assistance ProgramPart-Time Employees Also Get:Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Full-Time Employees Also Get:Full Benefits, including HSA, FSA, and Life & Disability InsuranceVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffYou’re Our Perfect Fit If...You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a jobyou seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights.Plus, you have the following: Completion of an accreditedPhysical Therapyprogram (New Grads Welcome) Current state licensure in PT Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! Professional curiosity and a knack for finding solutionsCome be a part of our mission to make a positive impact on the lives of seniors. Apply today! Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $36.00 - $45.00 per hour + $2,500 sign on bonus

Occupational Therapist - Inpatient We are seeking a dedicated Occupational Therapist to join our inpatient care team. In this role, you will help patients regain independence and improve their ability to perform daily activities following injuries, illnesses, or surgeries. Key Responsibilities: Evaluate patients' physical, cognitive, and emotional abilities to develop individualized treatment plans.Design and implement therapeutic interventions to enhance patients' daily living skills and independence.Collaborate with interdisciplinary teams, including physicians and nurses, to ensure comprehensive care plans.Educate patients and families on strategies to maintain progress after discharge.Document patient progress and adjust treatment plans as necessary. Work Environment: The role is based in hospital inpatient units where occupational therapists assist patients recovering from surgeries, strokes, or other acute conditions.This position may require standing for extended periods and assisting patients with mobility or task modifications. Benefits: A competitive salary with opportunities for career growth within inpatient rehabilitation settings.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance skills as an occupational therapist. Equal Opportunity Employer: Your expertise is valued here. We are committed to fostering an inclusive environment where all employees can thrive professionally while delivering exceptional care to our patients during their recovery journeys. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Overview: Physical Therapist Assistant (PTA)Your Schedule, Your Way!What sets EmpowerMe Wellness apart from other therapy providers It’s simple: we offer truly flexible scheduling. Need to be home for family or other obligations No problem! You can easily adjust your day to fit your needs all while making a huge difference in the lives of seniors!Incentive OpportunitiesFor some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The OpportunityWe are hiring a Physical Therapist Assistant (PTA) to join our team and work with the residents of a senior living community that offers one or more of the following care settings: independent living, assisted living, and memory care. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part B. As a PTA, you will be responsible for: Providing physical therapy and wellness services for older adults under the supervision of a PTMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesContributing to program development, quality improvement, and problem-solvingAssist with optimizing each patient’s functional well-being and satisfactionYour ScheduleWhile our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle!Our Amazing BenefitsAll Employees Get: Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind! 401(k) Eligibility with Opportunity for Matching FundsAmazing Career Advancement and Cross Training OpportunitiesRecognition ProgramsEmployee Assistance ProgramPart-Time Employees Also Get:Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Full-Time Employees Also Get:Full Benefits, including HSA, FSA, and Life & Disability InsuranceVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffYou’re Our Perfect Fit If...You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a jobyou seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights.Plus, you have the following: Completion of an accredited Physical Therapy Assistant program (New Grads Welcome) Current PTA state licensure Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! Professional curiosity and a knack for finding solutionsCome be a part of our mission to make a positive impact on the lives of seniors. Apply today! Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $33.00 - $46.00 per hour

Physical Therapist - Home Health Join our team as a dedicated Physical Therapist in Home Health, where you will help patients improve movement, manage pain, and regain independence in the comfort of their own homes. Key Responsibilities: Review patient medical histories and conduct assessments to diagnose movement dysfunction and identify patient goals.Develop and implement individualized treatment plans that may include hands-on therapy, exercises, and use of assistive equipment.Provide skilled physical therapy services in accordance with a physician’s plan of care, adapting interventions to the home environment.Educate patients and family members about the recovery process, safe mobility, and home exercise programs.Monitor and document patient progress, modifying treatment plans as needed to achieve optimal outcomes.Communicate and collaborate with physicians, nurses, and other healthcare professionals to coordinate care.Supervise and instruct Physical Therapist Assistants or Aides as required.Ensure all documentation is completed promptly and accurately in compliance with agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires strong communication, organizational skills, and the ability to work independently. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance expertise in home health physical therapy. Equal Opportunity Employer: Your commitment to helping patients regain independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Overview: Licensed Physical Therapist Assistant (PTA) - Care Coordination ProgramPhysical Therapy + Care Coordination: The Best of Both Worlds!We’re looking for Physical Therapy Assistants to support our innovative new care coordination program! This opportunity empowers you to practice at the top of your license, while giving you the chance to branch out into care coordination duties designed to standardize your hours and grow your career. All this plus truly flexible scheduling, amazing benefits, and the ability to make a huge difference in the lives of seniors!Incentive OpportunitiesFor some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The OpportunityWe are hiring a licensed Physical Therapist Assistant (PTA) to join our team and work with the residents of a senior living community that offers one or more of the following care settings: independent living, assisted living, and memory care. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part B. As a PTA, you will be responsible for: Providing physical therapy and wellness services for older adults under the supervision of a PT as part of a multidisciplinary teamSupport care coordination efforts by conducting regular wellness checkpoint visits with patients, communicating with patients’ providers and caregivers, and assisting patients with attending telehealth visitsMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesContributing to program development, quality improvement, and problem-solvingAssist with optimizing each patient’s functional well-being and satisfactionYour ScheduleWhile our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle!Our Amazing BenefitsAll Employees Get: Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind! 401(k) Eligibility with Opportunity for Matching FundsAmazing Career Advancement and Cross Training OpportunitiesRecognition ProgramsEmployee Assistance ProgramPart-Time Employees Also Get:Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Full-Time Employees Also Get:Full Benefits, including HSA, FSA, and Life & Disability InsuranceVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time Off Qualifications: You’re Our Perfect Fit If...You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a jobyou seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights.Plus, you have the following: Completion of an accredited Physical Therapy Assistant program (New Grads Welcome) Current PTA state licensure Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! Professional curiosity and a knack for finding solutionsCome be a part of our mission to make a positive impact on the lives of seniors. Apply today!About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $33.00 - $46.00 per hour

Occupational Therapist - Home Health Join our team as a dedicated Occupational Therapist in Home Health, where you will help patients regain independence and improve their ability to perform daily activities in their own homes. Key Responsibilities: Assess patients’ functional abilities and develop individualized treatment plans to address self-care, mobility, and safety needs.Implement therapeutic interventions to improve patients’ ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs).Educate patients and caregivers on adaptive equipment, home modifications, and strategies to enhance independence.Monitor and document patient progress, adjusting treatment plans as needed to achieve optimal outcomes.Collaborate with physicians, nurses, and other healthcare professionals to coordinate care and support patient goals.Ensure timely and accurate documentation in compliance with agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires creativity, problem-solving skills, and the ability to work independently while supporting patients and families. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance expertise in home health occupational therapy. Equal Opportunity Employer: Your dedication to helping patients achieve independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role Reporting to the Chief Medical Officer, the Senior Medical Director, Clinical Strategy will define the vision and priorities for Blue Shield of California’s strategy to deliver best in class clinical outcomes for our members while working to ensure that health care is affordable. In this role you will be accountable for working in partnership with other leaders to deliver best in class clinical programs and align our value-based care models to meet our clinical strategy objectives. Your WorkIn this role, you will:Develop a clinical strategy framework and guiding principles, grounded in data on population health outcomes and cost, to deliver Best in Class clinical outcomes for Blue Shield of California membersDefine the organization’s overall clinical strategy, as relates to priorities, partnerships, and key measures of success to improve member experience, population health and affordability, inclusive of primary care and specialty careCo-chair the Clinical Program Review and Governance Committee with the Chief Medical Officer to ensure that all clinical programs are delivering expected clinical and cost of care outcomes for our membersWork with teams performing vendor management to ensure that contracts include appropriate metrics to ensure programs are meeting operational targets to achieve clinical objectivesCollaborate with the Health Economics team to develop the methodology to evaluate the effectiveness and lead a process to ensure robust evaluation of all clinical programsCollaborate with business leaders to ensure that the clinical strategy and clinical programs are meeting business, client, and member needsCreate an environment of accountability and continuous quality improvement to ensure that all clinical programs continue to meet and exceed objectives necessary to deliver best in class clinical outcomes for Blue Shield of California membersCommunicate internally and externally the vision and strategy to transform healthcare to deliver Best in Class clinical outcomes for Blue Shield of California membersYour Knowledge and ExperienceMinimum of 2 years of previous medical leadership experienceMinimum of 5 years of direct patient care experience post residencyMinimum 4 years experience in observational study design and execution and/or clinical program evaluationMedical degree (M.D./D.O.)Maintain active, unrestricted California State Medical License required; Maintain active, unrestricted Medical License in all additional assigned states requiredMaintain Board Certification in one of ABMS, ABOS, or AOA recognized specialty requiredOutstanding verbal and written communication skillsAbility to lead through influence in a matrixed organizationMasters or PhD in Health Services Research, Epidemiology, Biostatistics or similar field preferredExperience in a health plan or managed care organization is preferred

Respiratory Therapist - ICUWe are seeking a skilled and compassionate Respiratory Therapist to join our Intensive Care Unit (ICU) team. In this role, you will provide critical respiratory care to patients with severe breathing disorders or life-threatening conditions, ensuring optimal outcomes through advanced therapeutic interventions.Key Responsibilities:Assess, treat, and monitor patients with acute or chronic respiratory conditions in the ICU setting.Initiate and manage mechanical ventilation and other life-support systems for critically ill patients.Administer aerosol medications, oxygen therapy, and other respiratory treatments as prescribed.Perform diagnostic tests such as arterial blood gas analysis and pulmonary function testing to evaluate lung performance.Collaborate with physicians, nurses, and other healthcare professionals to develop and implement individualized care plans.Respond to emergency situations, including rapid response or code blue events, to provide airway management and support.Maintain accurate patient records and document all treatments and progress in compliance with hospital policies.Educate patients and families on respiratory care techniques and equipment use when transitioning out of the ICU.Work Environment:Work in a fast-paced ICU environment that requires critical thinking and quick decision-making skills.Collaborate closely with a multidisciplinary team dedicated to providing life-saving care.Be prepared for rotating shifts, including nights, weekends, and holidays, as required in critical care settings.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through specialized training and certifications in critical care.A supportive work environment that values teamwork and innovation in patient care delivery.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Network and Trend Analytics team drives the development of an affordable provider network through data analytics and expertise. The Experienced Actuarial Analyst will report to the Senior Principal and will perform actuarial analysis primarily supporting the Behavioral Health provider network.Your Work In this role, you will: Understand the core principles and functionality of decision, descriptive, predictive and prescriptive analytic methods including forecasting, statistical and machine learning techniquesConduct 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 efficienciesDirect, coordinate, and/or develop evaluation and financial reporting standards for internal and external reportsUnderstand and accurately track the unit cost trend, support database upgradeGenerate reports and analysis from unit cost tracking database, respond to requests from inside and outside of the teamYour Knowledge and Experience Requires a bachelors degree with at least a minor in mathematics, statistics, computer science or equivalent business experienceRequires at least 2 years of professional actuarial experienceRequires proficiency in Excel and AccessPrefers proficiency in VBA and SAS

Speech-Language Pathologist - OtherWe are seeking a versatile Speech-Language Pathologist to join our team. In this role, you will assess and treat individuals with diverse communication and swallowing disorders in various settings, helping them improve their quality of life.Key Responsibilities:Evaluate patients to identify speech, language, or swallowing difficulties.Develop and implement individualized treatment plans tailored to specific needs.Provide therapy focused on articulation, fluency, voice quality, and cognitive-communication skills.Educate patients and families on strategies to support communication and swallowing improvements.Collaborate with other healthcare professionals to ensure comprehensive care.Document patient progress and adjust therapy plans as needed for optimal outcomes.Work Environment:Work in varied environments such as private practices, hospitals, or community health programs.Engage in a dynamic setting requiring adaptability and innovative problem-solving skills.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through training and certifications.A supportive work environment focused on collaboration and innovation in patient care.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Network Contracting and Trend Analytics (NTA) team supports the Network Management team with analytical and financial modeling for provider contracting and network development activities for Blue Shield of California. The Senior Principal, Medical Informatics of NTA will report to the Senior Director of NTA. In this role you will be responsible for behavioral health finance analytics including measurement of internal cost of healthcare and reporting, analytics supporting coordination of care opportunities, and oversight of provider contracting analytics. 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, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.Your Work In this role, you will: Develop the financial management and modeling best practices, specifically for Behavior Health as we move to an in-sourced environmentImplement on-going behavior health costs analysis and trendsBe responsible for CoHC - Behavior HealthBe the lead on modeling the financial aspects. Example, evaluating the financial aspects of care activities such as hospital ER vs behavioral health servicesLead all financial aspects in developing Value-Based Contracting, specifically in Behavior Health marketplace.Be accountable for development of the financial contractual arrangements and the implementation of these providers, which we are bringing in house Your Knowledge and Experience Requires a college degree or equivalent experienceMPH, MBA, MS, MA, RN, or RHIA preferredRequires 10 years of relative experienceRequires a minimum of 5 years’ experience in Health Care (managed care, academic, or gov't payer)Requires contracting in healthcare with a behavioral health specialtyRequires experience developing programs that will translate into CoHC savings specifically in extensive vendor knowledge of financial healthcare within behavioral healthRequires experience with behavioral health financial reporting and modelingRequires one to be comfortable with an ever changing business model that is continually seeking the optimal solution in the behavioral health spaceRequires a SAS Certified Base Programmer Credential or equivalent or a SAS Certified Advanced Programmer Credential or equivalent

Physical Therapist Assistant - Home Health Join our team as a dedicated Physical Therapist Assistant in Home Health, where you will work under the supervision of physical therapists to help patients regain movement and manage pain in their own homes. Key Responsibilities: Assist physical therapists in providing physical therapy treatments and procedures as outlined in the care plan.Observe and document patients’ status before, during, and after therapy, reporting progress and concerns to the supervising physical therapist.Help patients perform specific exercises and use therapeutic equipment safely in the home environment.Educate patients and family members about exercises and activities to continue between visits.Adapt interventions as needed within the scope of the treatment plan and state laws.Ensure all documentation is accurate and completed in a timely manner according to agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires strong interpersonal skills and the ability to work independently while supporting patient goals. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain certification and enhance expertise in home health physical therapy assistance. Equal Opportunity Employer: Your commitment to helping patients regain independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Middle Market underwriting team is responsible for balancing operating income and membership goals while protecting the company’s bottom line from loss. The Underwriter - Large Group, Experiencedwill report to the group underwriting manager. In this role you will directly contribute to the company achieving its financial and strategic goals for employer accounts with 101 or more eligible subscribers. Your Work In this role, you will: Collect, review and analyze customer specific information including financial condition, employee demographics, carrier history and previous claim experience to determine risk, potential benefit features and premium rates for fully insured groups requiring minimal customizationUnderwrite new and renewal business by calculating monetary risk along with amendments to existing contractsAssist as necessary in the negotiation of benefit plan designs and financial assumptions with sales teams on new and renewed businessReview and approve all sales requests within company established standards and policy guidelinesReview and interpret ad hoc reports as requested and produce ongoing reportsMay assist the sales team in implementing new and existing contracts by reviewing final enrollment numbersProvides underwriting knowledge sharing and education to peers and/or members of the sales teamYour Knowledge and Experience Requires a bachelor's degree in a related field such as finance, mathematics or accounting and/or equivalent combination of education and experienceRequires at least 3 years of prior relevant experienceRequires working knowledge of underwriting principles and proceduresRequires demonstrated math/statistical, analytical and problem-solving skillsRequires an attention to detail and accuracy and understanding of the company’s revenue, operating income and membership goalsRequires ability to solve complex problems with sometimes ambiguous informationRequires good time management and customer service skills

Physical Therapist - Home Health Join our team as a dedicated Physical Therapist in Home Health, where you will help patients improve movement, manage pain, and regain independence in the comfort of their own homes. Key Responsibilities: Review patient medical histories and conduct assessments to diagnose movement dysfunction and identify patient goals.Develop and implement individualized treatment plans that may include hands-on therapy, exercises, and use of assistive equipment.Provide skilled physical therapy services in accordance with a physician’s plan of care, adapting interventions to the home environment.Educate patients and family members about the recovery process, safe mobility, and home exercise programs.Monitor and document patient progress, modifying treatment plans as needed to achieve optimal outcomes.Communicate and collaborate with physicians, nurses, and other healthcare professionals to coordinate care.Supervise and instruct Physical Therapist Assistants or Aides as required.Ensure all documentation is completed promptly and accurately in compliance with agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires strong communication, organizational skills, and the ability to work independently. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance expertise in home health physical therapy. Equal Opportunity Employer: Your commitment to helping patients regain independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The End-to-End Member Experience team is responsible for developing a comprehensive Member Experience (MX) strategy that integrates digital, call center, marketing, and operations efforts to achieve excellence within the healthcare industry. The End-to-End Member Experience Strategic Insights, Consultant will report to the Senior Manager, Strategic Insights for End-to-End Member Experience. In this role, you will design, manage, and conduct MX research in collaboration with external vendors and internal stakeholders to inform the optimization of member experiences specific to Blue Shield members, all while driving our Net Promoter Score (NPS) and Forrester program performance.Your WorkIn this role, you will:Drive MX strategy by generating insights to prioritize and refine the MX roadmap, focusing on initiatives to enhance the experience for all membersSynthesize complex data and concepts into easily understood stories and recommendations for senior leadership and cross-functional teams, by scaling our NPS and Forrester programsSupport the Voice of the Customer (VoC) programs and collaborate across the organization to translate member reported issues into effective actionable resultsDerive insights and trends from data and analytics to create high-level strategies to drive optimization of customer experience and enhancement of loyaltyIdentify critical short and long-term business opportunities that enable transformational change across the enterpriseSynthesize complex data and concepts into easily understood stories and recommendations for senior leadership, by scaling our NPS & Forrester programsProduce impactful insights by leveraging expertise in survey design, statistical analysis, and data-driven storytellingCollaborate with internal teams to leverage insights in the development of journey maps and action plansNavigate ambiguity through strategic thinking, identify and implement improvements to various processes, programs, and tools used in support of the VoC best practicesOwn monthly, quarterly, and annual reporting, sharing insights in presentations to internal teamsYour Knowledge and ExperienceRequires a bachelor’s degree or equivalent experience and/or equivalent combination of education and experienceRequires at least 7 years of prior relevant experience, including in Member or Customer Experience, Voice-of-Customer programs (e.g., CAHPS, Digital MSAT, NPS, Forrester, etc.) or Market ResearchRequires ability to analyze ambiguous feedback from members/customers, employees, and other sources to turn into actionable insights for practical useRequires experience with tools to analyze and interpret member feedback data (e.g., Tableau, Vendor managed software, etc.)Requires experience with applying a variety of data analysis techniques and combining survey and operational dataExperience in customer experience program reporting, design, and roadmap development, in roles such as analyst, program manager, or adjacent strongly preferredExperience managing customer experience improvement projects from insights to building business cases to managing implementation (working with cross-functional teams), strongly preferredStrong communicator, self-starter, strategic thinker with a blend of business understanding and quantitative skills#LI-AD3