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Full Time
6/6/2025
Corona, CA 92882
(17.5 miles)
This is a PRN positionCompetitive pay based upon years of experience and applicable certifications, with competitive shift differential!Your Calling, Close to Home and HeartAre you in pursuit of a career that's more than a job, one that aligns with your heart and community We believe in the power of creating positive change within local communities through exceptional Occupational Therapy services, empowering individuals toward independence and an improved quality of life. Envision the opportunity to profoundly impact patients' lives, providing vital care and support, and contributing to inspiring outcomes. If this resonates, you're in the right place. As an Occupational Therapist, your role thrives on recognizing the significance of small victories in driving substantial change. Utilize your specialized skills to deliver top-tier, compassionate, and personalized care to our rehabilitation patients. Embrace a supportive team environment infused with motivation and joy in their work, granting access to cutting-edge technology. Start a rewarding career with comprehensive benefits, ensuring your peace of mind and professional growth from day one. Welcome to a fulfilling career journey where your care brings lasting impact and personal fulfillment.A Glimpse into Our WorldWhether you're laying the foundation of your career or a seasoned Occupational Therapist in search of a nurturing environment to call home, we are confident you'll feel the difference the moment you join our team. Being at Encompass Health means being a part of a growing national inpatient rehabilitation leader. We take pride in our career growth opportunities and the collaborative spirit of our team members, united for the greater good of our patients. Our recognitions, including being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, make us immensely proud.Benefits That Begin With YouOur benefits are designed to support your well-being and start on day one:Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.Generous paid time off that accrues over time.Tuition reimbursement and continuous education opportunities for your professional growth.Company-matching 401(k) and employee stock purchase plans, securing your financial future.Flexible spending and health savings accounts tailored to your unique needs.A vibrant community of individuals who are passionate about what they do.Be the Occupational Therapist You've Always Aspired to BeYour impactful journey involves:Providing direct care to patients in need of occupational therapy.Guiding patients by supervising care and treatments, leading patient assessments, creating personalized care plans, and targeting and resolving patient concerns.Building meaningful relationships with patients by dedicating time to understand their physical, mental, and emotional needs for a successful recovery.Celebrating patient victories along the way. QualificationsCurrent licensure or certification required by state regulations.CPR certification.Master's Degree preferred, or Bachelor's Degree plus sufficient experience in the field.The Encompass Health WayWe proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.We're looking forward to meeting you, and we truly mean that. Join our family, and let's make a positive impact together!
Full Time
6/19/2025
Riverside, CA 92503
(25.2 miles)
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.*
Full Time
6/10/2025
Long Beach, CA 90899
(16.2 miles)
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
Full Time
6/19/2025
Pasadena, CA 91105
(23.6 miles)
When you join the Huntington Hospital team, you are aligning yourself with an organization whose values drive our philosophy of compassionate community care. Over the past 129 years, we’ve grown from a small 16-bed hospital to a nationally recognized healthcare leader with 619 beds. As part of our commitment to providing equitable, high-quality care to all members of our community, we embrace differences and work hard to create a place of belonging for our patients and our employees. When you join the Huntington family, you’ll be empowered to enact change that continuously improves our ability to deliver world-class care, with kindness and dignity, to all who need it.** Internal Workers – Please log into your Workday account to apply **Huntington Hospital Employee LoginCompensation Range:Anticipated compensation range of $23.00 - $32.20 / Hour depending on qualifications and experience.*12 hour shifts at Huntington Health are overtime-based (not a straight time rate for all 12 hours). Therefore, employees who work a full 12-hour shift will be paid their base rate for 8 hours AND overtime (1.5) for hours up to 12.Department:617101 Med Tele Stn45Expectations:Provides direct patient care service on a patient-centered care unit as determined by the patient's plan of care and supervised by a Registered Nurse. This position may require flexibility of hours.EDUCATION:High school diploma or G.E.D. equivalency.EXPERIENCE/TRAINING:One year of prior experience in clinical patient care in an acute care setting (Current CNA may be substituted for the one year experience requirement).Basic computer skills/experience with computerized documentation systems preferred.Knowledge/experience with use of medical terminology.LICENSES/CERTIFICATIONS:Required:Current Basic Life Support Provider (BLS) issued by American Heart AssociationSKILLS:Must have working knowledge of departmental equipment needed to safely & successfully perform duties.Must be able to multi-task as needed and communicate effectively and timely to team lead/RN.Must complete and maintain competency skills required by specific department/unit.Must be able to perform in a fluctuating/dynamic environment.Where applicable, performs cardiac surgery prep per infection prevention standards.Where applicable, ensures monitoring devices are managed per policy and infection prevention standards; including cardiac/telemetry, infant security.When applicable, under the direction of the RN, contributes to mobility goals, safe patient handling and use of lift/mobility equipment.Where applicable, follows clinical pathway or additional requirements for specific patient populations, including Trauma, Stroke, Bariatric, Orthopedic and Oncology.For Emergency Services: When directed by nursing/physician leaders, performs 12-lead ECGs per cardiology standards.For care of Behavioral Health population: maintains safety of self and environment to ensure patient safety.Worker Type:RegularPart timeShift:Days
Full Time
6/6/2025
Corona, CA 92882
(17.5 miles)
This is a PRN positionCompetitive pay based upon years of experience and applicable certifications, with competitive shift differential!Your Calling, Close to Home and HeartAre you in pursuit of a career that's more than a job, one that aligns with your heart and community We believe in the power of creating positive change within local communities through exceptional Occupational Therapy services, empowering individuals toward independence and an improved quality of life. Envision the opportunity to profoundly impact patients' lives, providing vital care and support, and contributing to inspiring outcomes. If this resonates, you're in the right place. As an Occupational Therapist, your role thrives on recognizing the significance of small victories in driving substantial change. Utilize your specialized skills to deliver top-tier, compassionate, and personalized care to our rehabilitation patients. Embrace a supportive team environment infused with motivation and joy in their work, granting access to cutting-edge technology. Start a rewarding career with comprehensive benefits, ensuring your peace of mind and professional growth from day one. Welcome to a fulfilling career journey where your care brings lasting impact and personal fulfillment.A Glimpse into Our WorldWhether you're laying the foundation of your career or a seasoned Occupational Therapist in search of a nurturing environment to call home, we are confident you'll feel the difference the moment you join our team. Being at Encompass Health means being a part of a growing national inpatient rehabilitation leader. We take pride in our career growth opportunities and the collaborative spirit of our team members, united for the greater good of our patients. Our recognitions, including being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, make us immensely proud.Benefits That Begin With YouOur benefits are designed to support your well-being and start on day one:Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.Generous paid time off that accrues over time.Tuition reimbursement and continuous education opportunities for your professional growth.Company-matching 401(k) and employee stock purchase plans, securing your financial future.Flexible spending and health savings accounts tailored to your unique needs.A vibrant community of individuals who are passionate about what they do.Be the Occupational Therapist You've Always Aspired to BeYour impactful journey involves:Providing direct care to patients in need of occupational therapy.Guiding patients by supervising care and treatments, leading patient assessments, creating personalized care plans, and targeting and resolving patient concerns.Building meaningful relationships with patients by dedicating time to understand their physical, mental, and emotional needs for a successful recovery.Celebrating patient victories along the way. QualificationsCurrent licensure or certification required by state regulations.CPR certification.Master's Degree preferred, or Bachelor's Degree plus sufficient experience in the field.The Encompass Health WayWe proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.We're looking forward to meeting you, and we truly mean that. Join our family, and let's make a positive impact together!
Full Time
6/19/2025
Riverside, CA 92503
(25.2 miles)
Physical Therapist Assistant (PTA) We are seeking a dedicated Physical Therapist Assistant (PTA) to support licensed physical therapists in providing therapeutic care. In this role, you will help patients improve mobility, strength, and overall functionality through tailored treatment plans. Key Responsibilities: Assist physical therapists in implementing treatment plans designed to meet individual patient needs.Guide patients through therapeutic exercises and activities aimed at improving mobility and strength.Monitor patient progress during therapy sessions and document findings for review by the supervising therapist.Educate patients and families on exercises or techniques to continue therapy at home.Maintain a clean and organized treatment area and ensure equipment is properly maintained. Work Environment: The role is based in various settings such as hospitals, outpatient clinics, or rehabilitation facilities.This position requires physical stamina as it involves assisting patients with mobility exercises throughout the day. Benefits: A competitive salary with opportunities for career growth within physical therapy settings.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Access to continuing education programs to maintain certification and enhance skills as a PTA. Equal Opportunity Employer: Your commitment to improving patient outcomes is valued here. We strive to create 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.*
Full Time
6/10/2025
Long Beach, CA 90899
(16.2 miles)
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
Full Time
6/10/2025
Pasadena, CA 91105
(23.6 miles)
When you join the Huntington Hospital team, you are aligning yourself with an organization whose values drive our philosophy of compassionate community care. Over the past 129 years, we’ve grown from a small 16-bed hospital to a nationally recognized healthcare leader with 619 beds. As part of our commitment to providing equitable, high-quality care to all members of our community, we embrace differences and work hard to create a place of belonging for our patients and our employees. When you join the Huntington family, you’ll be empowered to enact change that continuously improves our ability to deliver world-class care, with kindness and dignity, to all who need it.** Internal Workers – Please log into your Workday account to apply **Huntington Hospital Employee LoginCompensation Range:Anticipated compensation range of $124,584.00 - $155,570.00 / Year depending on qualifications and experience.Department:617101 Med Tele Stn45Expectations:Responsible for assisting the Department Managers in supervising, planning, coordinating and evaluating patient care and employee performance. Ensures effective unit operation and supports staff with challenging issues, assists with care coordination and serves as first line on-site support/resource for employees, physicians and patients. Meets all job requirements of the Registered Nurse. This position requires flexibility of hours.EDUCATION:Bachelor's Degree in Nursing (BSN) required.EXPERIENCE/TRAINING:Minimum three (3) years of clinical experience in the specific area of expertise or equivalent service area, including at least 2 years of recent experience in the specific area of expertise or equivalent service area.Five (5) years of experience and demonstrated leadership capabilities preferred.LICENSES/CERTIFICATIONS:Required:Current unrestricted Registered Nurse (RN) license issued by California Board of Registered Nursing (BRN)Current Basic Life Support Provider (BLS), Advanced Cardiovascular Life Support (ACLS) issued by American Heart AssociationPreferred:Board Certification in Med-surg or any American Nurses Association (ANA) recognized professional nursing certification.SKILLS:Good managerial, communicative and organizational skills.Competency to utilize computer systems including Health Information System and Office applications at an intermediate level is expected.Worker Type:RegularFull timeShift:Nights
Full Time
6/6/2025
Corona, CA 92882
(17.5 miles)
Extra attention to detail Exceptional outcomes This is a PRN position BE THE CONNECTION.Your role as a certified occupational therapy assistant (COTA) lets you be the connection between dedication to detail and patient outcomes that exceed expectations. Use your passion for rehabilitation to ensure that patients receive care that sets the standard as you treat patients with compassion and empathy. Enhance the impact of your abilities with national post-acute care leader Encompass Health. What Makes Encompass Health Careers Different-and Better:Working at Encompass Health means being part of something special: A team that is passionate about making an impact on patients' lives each day. Unlike the typical hospital setting, Encompass Health offers you the unique opportunity to walk alongside patients on their road to recovery from stroke, spinal cord injuries, neurological disorders, joint replacements, multiple trauma and cardiac/pulmonary conditions. As you help patients achieve goals and regain independence, you can form significant relationships with them and celebrate the successes they experience along the way.Our culture of compassion and collaboration is founded on more than just the care we provide our patients; it is expressed in the values we live. We encourage and empower each employee to keep learning and growing by providing the resources to deliver a better way to care. At Encompass Health, you'll find something decidedly different and more satisfying: A career that is challenging, inspiring and rewarding. Maximize your talent and join a team that is committed to setting the standard for better healthcare with this engaging opportunity: CERTIFIED OCCUPATIONAL THERAPY ASSISTANT (COTA)Here is your opportunity to channel the full extent of your knowledge, skills, ambition, and experience on a daily basis. Inspire our patients to progress each day as you:• Provide occupational therapy treatment and patient care according to hospital, state and federal regulations and professional guidelines.• Perform occupational therapy treatment tasks as delegated and supervised by occupational therapists.• Maintain open and ongoing communication with hospital departments to ensure that patient, staff and hospital needs are met. Credentials:• Current state licensure or certification or state practice act, whichever is applicable, required.• CPR certification preferred, unless otherwise required by hospital policy.• Successful completion of an associate's degree from an accredited occupational therapy assistant program preferred.• Effective communication skills for working with patients, families and caregivers required.• Demonstrated competency in occupational treatment essential. Enjoy competitive compensation and benefits that start on day one, including: • Benefits that begin when you do.• Affordable medical, dental and vision plans provided to meet the needs of full and part-time employees and their families.• Generous paid time off that increases with tenure.• Tuition reimbursement and continuing education opportunities.• Company-matching 401(k) and employee stock-purchase plans.• Flexible spending and health savings accounts. About Us:Helping patients regain hope and independence, Encompass Health is a national leader in post-acute care. We operate rehabilitation hospitals and offer home health and hospice care in 36 states as well as Puerto Rico. Following the Encompass Way, we are driven by our core values: We proudly set the standard, lead with empathy, do what's right, focus on the positive, and remain stronger together. Realize the powerful difference you can make. Take this opportunity to join our team.To learn more about us, please visit us online at encompasshealth.com Connect with us:Equal Opportunity Employer QualificationsCompensation: $45.00 an hour
Full Time
6/10/2025
Long Beach, CA 90899
(16.2 miles)
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.
Full Time
5/30/2025
Pasadena, CA 91105
(23.6 miles)
When you join the Huntington Hospital team, you are aligning yourself with an organization whose values drive our philosophy of compassionate community care. Over the past 129 years, we’ve grown from a small 16-bed hospital to a nationally recognized healthcare leader with 619 beds. As part of our commitment to providing equitable, high-quality care to all members of our community, we embrace differences and work hard to create a place of belonging for our patients and our employees. When you join the Huntington family, you’ll be empowered to enact change that continuously improves our ability to deliver world-class care, with kindness and dignity, to all who need it.** Internal Workers – Please log into your Workday account to apply **Huntington Hospital Employee LoginCompensation Range:Anticipated compensation range of $23.00 - $32.20 / Hour depending on qualifications and experience.*12 hour shifts at Huntington Health are overtime-based (not a straight time rate for all 12 hours). Therefore, employees who work a full 12-hour shift will be paid their base rate for 8 hours AND overtime (1.5) for hours up to 12.Department:617901 Cardiothoracic Tele Unit 5WExpectations:Provides direct patient care service on a patient-centered care unit as determined by the patient's plan of care and supervised by a Registered Nurse. This position may require flexibility of hours.EDUCATION:High school diploma or G.E.D. equivalency.EXPERIENCE/TRAINING:One year of prior experience in clinical patient care in an acute care setting (Current CNA may be substituted for the one year experience requirement). - For Emergency Services: EMT preferred - For Women's Services: Experience in OB equivalent, Couplet Care, preferred - For Behavioral Services: Prior one year experience in acute behavioral health setting, preferred.Basic computer skills/experience with computerized documentation systems preferred.Knowledge/experience with use of medical terminology.LICENSES/CERTIFICATIONS:Required:Current Basic Life Support Provider (BLS) issued by American Heart AssociationSKILLS:Must have working knowledge of departmental equipment needed to safely & successfully perform duties. Must be able to multi-task as needed and communicate effectively and timely to team lead/RN. Must complete and maintain competency skills required by specific department/unit. Must be able to perform in a fluctuating/dynamic environment.Where applicable, performs cardiac surgery prep per infection prevention standards.Where applicable, ensures monitoring devices are managed per policy and infection prevention standards; including cardiac/telemetry, infant security.When applicable, under the direction of the RN, contributes to mobility goals, safe patient handling and use of lift/mobility equipment.Where applicable, follows clinical pathway or additional requirements for specific patient populations, including Trauma, Stroke, Bariatric, Orthopedic and Oncology.For Emergency Services: When directed by nursing/physician leaders, performs 12-lead ECGs per cardiology standards.For care of Behavioral Health population: maintains safety of self and environment to ensure patient safety.Worker Type:RegularFull timeShift:Days
Full Time
6/10/2025
Long Beach, CA 90899
(16.2 miles)
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
Full Time
6/10/2025
Long Beach, CA 90899
(16.2 miles)
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
Full Time
6/19/2025
Long Beach, CA 90802
(18.5 miles)
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 WorkIn 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 BCBAExpert knowledge of Applied Behavior Analysis and Autism Spectrum DisordersConsiderable knowledge of Medi-Cal Managed CareDemonstrated 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
Full Time
6/6/2025
Long Beach, CA 90802
(18.5 miles)
YourRole TheCareManagement Department is seeking adedicated and compassionate Clinical Service Coordinator (CSC) to join our team.The Clinical Service Coordinatorwill report to the SupervisorofCare Operations.The CSC will play a vital role in outreach and engagement efforts with our members, introducing them to care management services, and conducting assessments to identify their needs. The successful candidate willinteract telephonically with members to assist with simple care coordination needs and facilitate connections between members and appropriate services, including internal nurse care managers, vendors, and behavioral health providers.YourWork Inthisrole,youwill:Conduct telephonic outreach efforts to engage members andintroduce them to care management services.CompletethoroughassessmentstoidentifymemberneedsandcaregapsMaintain accurateand up-to-datememberrecordsanddocumentation ofall interactions and services providedConductfollow-upcallstoensuremembers’needsarebeingmetProvide members with information and resources about available care management services and how to access themProvidesadministrative/clericalsupporttomedicalanddiseasemanagementprograms.Acts as aliaison, gathers information, and track all patients referred to the care management programs.Assists in coordinating care for specific high risk/high-cost patient population, including referrals tocommunity resources, facilitation ofmedical services, referral to ancillary providers,etc.Assistsinverifyinghealthplanbenefitsandcoordinatingambulatoryservices.Demonstratesculturalcompetencetoworkeffectively,respectfully,andsensitivelywithin the client’s cultural context.Assistswithpreceptingresponsibilitiesfornewhiresandauditingefforts. YourKnowledgeandExperience AminimumofahighschooldiplomaAminimumof3yearsofrelevantexperienceAminimumof1yearexperienceinamanagedcareenvironment.Bi-Lingual: Must be fluent in English and SpanishHealthinsurance/managedcareexperience(Commercial,Medicare,andMedi-Cal)CommunityresourcesandadvocacyAbilitytoidentifyissuesanddevelopeffectivesolutionstomeetmembers'needsFlexibilitytoadjusttochangingcircumstancesandmemberneedsStrong verbal and written communication skills to effectively convey information to members and colleagues
Full Time
6/10/2025
Long Beach, CA 90899
(16.2 miles)
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
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