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

Job Title:Supervisor Operations - Cold Food Dept - SFO HubJob Location:San Francisco-USA-94128Work Location Type:On-SiteSalary Range:$71,530.60 - 89,412.85About usLSG Sky Chefs is one of the world’s largest airline catering and hospitality providers, known for its outstanding reputation and dynamic approach in the industry. Voted “Airline Caterer of the Year in North America” for 2023 and 2024, we are committed to excellence and innovation, driven by the dedication and expertise of our talented employees. Our team members are the heart and soul of our success, consistently delivering exceptional culinary experiences and outstanding service to our clients and their passengers across North and Latin America.Role Purpose StatementOur San Francisco Operations Center providing airline catering for United Airlines is hiring! The Cold Food Operations Supervisor at Sky Chefs plays a critical role in overseeing and managing the preparation, storage, and distribution of cold food items in accordance with company standards, customer specifications, and food safety regulations. This position is responsible for supervising a team of kitchen staff, ensuring that all cold food items are prepared efficiently and meet quality standards. The supervisor will also manage inventory, monitor the adherence to food safety protocols, and work collaboratively with other departments to ensure seamless operations. The ideal candidate will have strong leadership skills, a deep understanding of food production processes, and a commitment to maintaining high standards of cleanliness and safety. This role is essential in ensuring that Sky Chefs delivers premium, high-quality cold food products to our airline and hospitality clients.Main AccountabilitiesResponsible for supervising the Cold Food Department and working closely with other department leadersEnsure that the area of responsibility is properly organized, staffed and directed and that all delivery times are being met timelyConduct daily work group meetingsMaintains all financial goals related to material, productivity, overtime, and labor goalsEnsure compliance with all government regulatory agencies standards (example: Food and Drug Administration (FDA), United Stated Department of Agriculture (USDA), Occupational Safety and Health Administration (OSHA), Environmental Protection Administration (EPA), Department of Transportation (DOT), Hazard Analysis and Critical Control Points (HACCP), etc.)Document and follow up on all department processes in order to implement improvementsOther duties as deemed necessaryLeadershipGuide, motivate and develop staffResponsible for performance evaluation, coaching, counseling and preparing corrective action for employees and liaises appropriately with HR and other support functionsManage productivity hours and costs in the area of responsibility; initiate and steer corrective actionsParticipate and support company sponsored initiatives such as Quality, HACCP, Lean Manufacturing, Employee Safety and Production systemsKnowledge, Skills and ExperienceAssociates/Bachelor’s degree or equivalent experienceIn addition, one to three years of supervisory experience in a food production and restaurant or catering environment or equivalent experienceFood handling and food safety knowledge experienceMust have strong and effective leadership and communication skills and the ability to successfully manage a staff of 20+ hourly employeesCandidate must be comfortable with all levels of employees and have the ability to drive positive program change.Ability to give negative and positive feedback to employees on a daily basisWorking knowledge of OSHA, Good Manufacturing Practice (GMP), FDA, USDA and EPA regulationsExcellent verbal, written and organizational skills required along with the ability to multi-taskGood knowledge of Microsoft Office and Windows-based computer applicationsLSG Sky Chefs is an EEO and Affirmative Action Employer of Women/Minorities/Veterans/Individuals with Disabilities.

Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial Utilization Management is critical to the success of Blue Shield of California (BSC) and the Utilization Management (UM) department in realizing its goals and objectives. This individual will play a key role as part of UM team in delivering and collaborating on all aspects of utilization management and care coordination for Commercial membership. The Director, Commercial Utilization Management role will also provide direction and leadership in compliance to regulatory requirements and key operational metrics. This role requires weekly travel to an approved BSC office, and monthly travel to the Rancho Cordova BSC office. Ad hoc travel as needed.Your WorkIn this role, you will:Manage and monitor prior authorization and concurrent review to ensure that the patient is getting the right care in a timely and cost-effective wayLead 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 savingsProvide analysis and reports of significant utilization trends, patterns, and resource allocation. Partner with physicians and others to develop improved utilization of effective and appropriate servicesEstablish and measure productivity metrics in order to support workforce planning methodology and rationalization of services required to perform UM reviewsReview and report out on Utilization Review (UR) trending for Commercial membershipEnsure alignment of the authorization strategy with clinical policy, payment integrity, and network development strategies to optimize quality and cost of careManage strategic projects and support operations initiativesLead operational implementation of transformation changes (organizational management, process implementation, technology adoption)Lead operational teams' performance, resource management, continuous improvement, and trainingLead operational audit readiness, ensure adequate processes and internal audit measures are in place and maintained quarterlyEnsure all operational processes are meeting regulatory and accreditation requirementsFoster a culture of process excellence, BSC leadership principles, and a great place to work environmentYour Knowledge and ExperienceRequires current CA RN LicenseBachelors of Science in Nursing or advanced degree preferredMaster’s degree or equivalent experience preferredMinimum of 10 years prior relevant experience, including 6 years of management experienceMinimum of 5 years of progressive leadership in Utilization Management operations, preferredHealth plan or similar health care organization structure experience requiredSuccessful track record in driving organizational change managementExcellent relationship and consensus-building skills required#LI-JS3

Job Title:Employee Experience Manager- SFO HubJob Location:San Francisco-USA-94010Work Location Type:On-SiteSalary Range:$98,275.82 - 122,844.77About usLSG Sky Chefs is one of the world’s largest airline catering and hospitality providers, known for its outstanding reputation and dynamic approach in the industry. Voted “Airline Caterer of the Year in North America” for 2023 and 2024, we are committed to excellence and innovation, driven by the dedication and expertise of our talented employees. Our team members are the heart and soul of our success, consistently delivering exceptional culinary experiences and outstanding service to our clients and their passengers across North and Latin America.Position SummaryThe Employee Experience Manager is a new and highly visible position that will heavily affect the organization! This position will oversee the first initiative in creating and implementing a program focused on providing a welcoming and positive employee experience during onboarding and throughout an employee’s career with LSG. The Employee Experience Supervisor will be the voice of employees and communicate any findings or concerns to Field Operations and Human Resources.PerksCareer Growth: We invest in your professional development and offer clear pathways for advancement.Competitive Salary + 401(k) Match – Secure your financial futureDay 1 Benefits – Medical, Dental, Vision, Life Insurance, AD&DTuition Reimbursement – Invest in your professional developmentExciting Perks: Free meals, free parking, and the opportunity to be part of an industry leader that’s setting new standards in airline hospitality.A Winning Culture: Collaborate with top-tier professionals and be part of a company that values innovation, teamwork, and excellence.Paid Time Off – Vacation, Sick Leave, and Holiday PayExclusive Perks – Membership to American Airlines Credit UnionHow You’ll Make an ImpactEstablish and ensure successful, productive, collaborative partnerships with local operations leaders and corporate partners to bring employee experience awareness into their processes, communications, and strategies.Design and execute effective initiatives focused on program improvement and increasing engagement - focus groups, surveys, etc.,Conducting surveys and analyzing feedback to assess employee satisfaction and well-being.Managing internal communication strategies to keep employees informed and engaged.Monitoring and optimizing employee touchpoints throughout the employee lifecycle.Developing and implementing training programs to enhance employee skills and performance.Supporting diversity and inclusion initiatives within the organization.Lead the partnership with operations leaders to launch and support the “Buddy” new hire onboarding program in their departments. Ensure compliance with program payments.Meet with new hires every week to recap and evaluate orientation and training, answer questions, and address concerns.Lead the weekly Employee Experience Internal Feedback Loop (IFBL) meeting to address new hire orientation evaluations and program updates, feedback, and ideas with leadershipAdminister and report weekly Employee Engagement scorecard on new hire's engagement level and other KPIsSend weekly reports to senior leaders on engagement trends, issues, training needs, etc.Organizing and coordinating employee events, recognition programs, and team-building activities.Analyzing data and metrics to measure the effectiveness of employee experience initiatives.What We Look For in a CandidateA Bachelor’s degree or equivalent experience is preferred.Minimum of 3-5years of experience performing root cause analysis, consulting leaders, and performing focus groups measuring employee retention, and performing focus groups.Experience a in metrics-based HR role with a focus on improving turnover, employee engagement, and processes is highly preferred.Thrives in a people-oriented environment, and demonstrates a collaborative leadership style at all levels of the organization. Demonstrates agility, strong interpersonal skills, and ability to lead and implement projects.An ability to solve problems without a manual.Demonstrates adaptability to changing situations or environments, and adjusts to work effectively within new situations, processes, and cultures.Strong flexible communication skills with the ability to convey ideas and concepts that are easily understood and retained by various audiencesAbility to lead work groups and teams to achieve results.Exceedingly self-motivated, directed and detail-orientedComfortable working in a service industry, light production environment.Basic to intermediate skills in Microsoft programs.#LSGNSLSG Sky Chefs is an EEO and Affirmative Action Employer of Women/Minorities/Veterans/Individuals with Disabilities.

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

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