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Full Time
6/10/2025
Pasadena, CA 91105
(39.5 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 $58.79 - $66.13 / Hour depending on qualifications and experience.Department:777001 O/P RehabExpectations:Performs diagnostic evaluation of patients with communication disorders and administers speech and language treatment to patients. Participates in the management of patient care to include identification of communicative disorders' diagnosis; linking and scheduling patient with required services, monitoring care delivery, advocating for the patient, and evaluating outcomes. The Speech Pathologist facilitates patient care across the health care continuum, and assists other team members.This position requires flexibility of hours.EDUCATION:Masters degree in Speech pathology, Language Pathology, or Communicative Disorders required.EXPERIENCE/TRAINING:Determined by patient care area with 1 year related practice experience preferred.O/P Rehab: Experience working with neuro-rehabilitation patients preferred, including TBI, SCI, and stroke.LICENSES/CERTIFICATIONS:Required: Current unrestricted Speech Pathologist License (SLP) issued by state of California Department of Speech-Language Pathology and Audiology and Hearing Aid Dispensary BoardCurrent Basic Life Support Provider (BLS) issued by the American Heart AssociationSKILLS:Patient population for outpatient Speech Pathologists does not include Neonates nor Infants/ToddlersWorker Type:Per DiemPart timeShift:Days
Full Time
6/7/2025
Pomona, CA 91769
(37.3 miles)
Physical Therapist Career Opportunity This is a PRN position Join a Team That Puts Your Passion for Care FirstAre you seeking a fulfilling career that feels like home and lets you make a meaningful impact At Encompass Health, you'll find an opportunity to provide exceptional care and support to our patients, witnessing their remarkable progress firsthand. As a Physical Therapist, your specialized skills will help deliver high-quality, compassionate care, allowing you the time to deeply understand and guide patients on their rehabilitation journey. Our well-equipped physical therapy gyms, backed by the latest technology, foster a supportive, driven, and welcoming environment. From day one, you'll experience a rewarding career and comprehensive benefits that prioritize your peace of mind and professional growth. Welcome to a place where your passion for care fuels remarkable progress and fulfillment. A Glimpse into Our WorldWhether you're at the early stages of your career, seeking to build a strong foundation, or an experienced Physical Therapist in search of a better environment to call home, you'll experience the difference the moment you become a part of our team. Being at Encompass Health means being with a growing national inpatient rehabilitation leader. We take immense pride in our career growth opportunities and how our team collaborates for the greater good of our patients. Our achievements, including being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, make us truly remarkable. Our Commitment to 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 advancement.Company-matching 401(k) and employee stock purchase plans for a secure financial future.Flexible spending and health savings accounts tailored to your unique needs.A community of individuals passionate about what they do. Be the Physical Therapist You've Always Aspired to BeYour journey involves:Providing direct inpatient care to patients in need of physical therapy.Supervising care and treatments, leading patient assessments, creating personalized care plans, and addressing patient concerns.Building meaningful relationships with patients by taking the time to understand their physical, mental, and emotional needs to support their recovery.Celebrating every victory along the way. QualificationsCurrent licensure or certification as 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 eager to meet you, and we truly mean that. Join our family, and let's make a difference together!
Full Time
6/10/2025
Torrance, CA 90505
(33.9 miles)
Overview: Licensed Physical Therapist (PT) - Care Coordination ProgramPhysical Therapy + Care Coordination: The Best of Both Worlds!We’re looking for Physical Therapists 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! Responsibilities: The OpportunityWe are hiring a licensed Physical Therapist (PT) 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 PT, you will be responsible for: Providing physical therapy and wellness services for older adultsConducting assessments, treatment plannings, and therapeutic interventions 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-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 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 program (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!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 - $60.00 per hour
Full Time
6/1/2025
Los Angeles, CA 90079
(37.3 miles)
Join Talkspace, a leading online platform for therapists and counselors to provide mental health care on your schedule, all from the comforts of home. This is a remote, part-time position for therapists and counselors independently licensed in California. The Benefits: Choose Your Time Commitment - As a Talkspace therapist, there is no caseload requirement or non-compete clause so you can keep your current clientele. Use Talkspace to fill in openings in your schedule or build a full caseload on our platform - up to you!No Overhead - Wave goodbye to insurance barriers, marketing budgets, and other expenses associated with private practice. Talkspace provides client referrals to you & handles insurance claim submission and billing so you can focus on practicing the craft you love.Flexible Scheduling - Provide mental health care on your time, whether that’s during the day, evenings, or on the weekend. In fact, many clients are available and look for care on weekends and at night! Set a schedule that works best for you & your clients.Bonuses - Earn bonuses for engagement with new clients!AI Assistance - Our HIPAA-compliant AI tools expedite session preparation by providing a summary of key details from previous sessions and accelerate session documentation by drafting progress notes after each session. Usage is encouraged but optional.And More! - Manage cases, write client notes, and schedule appointments all on the Talkspace app. Earn free CE credits by attending our Learning Community sessions. You’ll also have access to resources like our Provider Help Center and our dedicated Provider Support Team. Requirements:All therapists & counselors who wish to join Talkspace must possess and provide proof of: Independent, state-board-approved clinical license (e.g., LPC, LMHC, LCSW, LMFT)Individual professional malpractice liability insurance policyIndividual NPI & CAQH numbersCurrent residence in the USA Compensation:You will be reimbursed $90 for 60-minute live sessions with California clients; compensation for sessions is determined by the state in which your client resides. Rates for shorter live sessions (30- and 45-minute) are prorated. Asynchronous messaging rates fluctuate depending on client plans and their state of residence. Finally, we offer bonuses based on engagement with new clients. How does Talkspace work Talkspace is an online platform that matches mental health therapists / counselors with clients in their licensed state(s) through an easy-to-use and HIPAA-compliant app. Hold live sessions or exchange messages with your clients from almost anywhere, at any time! Note: Due to demand, we currently place providers on a waitlist to join Talkspace if they ONLY have clinical licensure in the following states: TX, FL, NC, MI Job Type: Full-Time, Part-Time, Contract, Remote
Full Time
6/1/2025
Chatsworth, CA 91313
(37.3 miles)
ABOUT USTogether, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community. From our family to the nation’s schools, we remain focused on providing a world of opportunities for you to leverage your abilities and make an impact on special education. Apply today!POSITION DESCRIPTIONEpic Special Education Staffing is partnering with an exceptional school district who is looking for a contract School Certified Occupational Therapist for the 2025 - 2026 school year.·Duration: 08/11/2025 - 5/29/2026·Location: Chatsworth, CA·Location Type: On-Site·Schedule: Full Time·Hours: 32.5·Grade/Age Levels: High School·Weekly Pay Range: $51.75 – $59.51 per hour on a local contractBENEFITSWe offer a variety of benefits for you and your loved ones. As a valued and respected part of the Epic family, you will enjoy:·Competitive compensation packages for both local and travel contracts·Medical, Dental, and Vision benefits·Infertility & Domestic Partner Coverage·Summer Insurance Coverage·PTO & Holiday Pay·401K matching·Wellness and Employee Assistance Program (EAP)·CEU & license reimbursements·Referral bonuses of $1000QUALIFICATIONSThe minimum qualifications for School Certified Occupational Therapist:·1 year of verifiable, professional experience as School Certified Occupational Therapist within the last 3 years (may include residency or clinical practicum)·Valid School Certified Occupational Therapist credential/license or in process in state of practice·Employees must be legally authorized to work in the United States and will be asked for proof upon hire. We are unable to sponsor or take over sponsorship of an employment Visa at this time.·We will consider all qualified applicants for employment, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws.·Epic Staffing Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, housing, age, disability or genetics.At Epic Special Education Staffing, you will have the opportunity to apply your unique experience and expertise with school-based special education as your singular focus. We offer stimulating and rewarding careers that provide an opportunity to make a difference in a child's life! We appreciate referrals! Let us help your friends find a great place to call home! Ask your recruiter how you can receive a $1,000 referral bonus and $250 charitable donation!By applying for this position, you agree that any calls from Epic Staffing Group and its subsidiaries may be monitored or recorded for training and quality assurance purposes.
Full Time
6/10/2025
Long Beach, CA 90899
(43.7 miles)
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
Full Time
6/10/2025
Pasadena, CA 91105
(39.5 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 $39.00 - $46.80 / Hour depending on qualifications and experience.Department:846001 Clinical TechnologyExpectations:Performs both routine and complex tasks associated with the installation, maintenance, safety testing and repair of a diverse range of clinical equipment, which may include life support. This position requires flexibility of hours.EDUCATION:Biomedical technology certification/diploma or Associate degree or higher in a related field.EXPERIENCE/TRAINING:Two to five years of related experience.LICENSES/CERTIFICATIONS:Preferred:Current Certified Biomedical Equipment Technician (CBET) certificationSKILLS:Perform significant preventive maintenance/safety tests/calibration for medical equipment:- Performs calibration, preventive maintenance, and safety tests with limited supervision.- PM completion rate exceeds 90% for non-life support equipment.- PM completion rate achieves 100% for life support equipment.- Schedules PMs and informs the head of department in a timely fashion.- Documents entire procedure including follow-up on "delinquent devices" on a monthly basis.- Completes assignments monthly.- Performs safety inspections per HMH CT’s PMP procedures.- Based on the results of the test, makes the immediate necessary corrections.- Can explain to the customer in common terms the testing results and necessary corrections.Worker Type:RegularFull timeShift:Days
Full Time
6/2/2025
Thousand Oaks, CA 91320
(8.7 miles)
Overview: Clinic Director – Licensed Clinical Occupational Therapy Assistant (COTA) - Care Coordination ProgramOccupational Therapy + Care Coordination: The Best of Both Worlds!We’re looking for COTAs 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 licensedClinical Occupational Therapy Assistant (COTA) to serve as Clinic Director at 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 Clinic Director, you will be responsible for:Overseeing how team members at your location(s) deliver care in accordance with federal, state, and local regulations Support care coordination efforts by conducting regular wellness checkpoint visits with patients, communicating with patients’ providers and caregivers, and assisting patients with attending telehealth visitsLeading operational initiatives, including the implementation of company-wide policies, clinical programs, and quality initiativesCollaborating with interdisciplinary care partners on treatment planning and therapeutic interventionsMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesAs a COTA, you will be responsible for: Providing occupational therapy and wellness services for older adults under the supervision of a OT as part of a multidisciplinary teamContributing to program development, quality improvement, and problem-solvingAssisting 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 Clinical Occupational Therapy Assistant program (New Grads Welcome) Current COTA 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 - $45.00 per hour
Full Time
6/10/2025
Long Beach, CA 90899
(43.7 miles)
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.. The Clinical Services Coordinator, Advancedwill report to the Manager, Operations FCR. In this role you will assist the clinical team to ensure a timely review of facility compliance claims, including monitoring queues, assisting with administrative support to the FCR team This will includemanagement of daily inventory, assisting with researching claims, pulling medical records and answering questions sent to the FCR mailbox. The main goal of this team is to support the clinical team to ensure they have what they need in order to complete the medical necessity reviews.Your Work In this role, you will: Process faxed/phoned in authorizations, UM/CM requests, special processing/case types and/or calls left on voicemailMonitor specific queues/workstreams andgeneratespre-defined reports to identify and resolve common errorsHandle customer/provider problematic callsCheck member history for case management triageand research member eligibility/benefits and provider networksAssign initial EOA days, or triage to nurses, based on established workflowAssists with system letters, requests for information and data entry. Monitors for Medical Records Outstanding (MRO), keeps track to ensure timely receipt and filing of medical records. **Requires occasional visits to the office to collect these medical records. Provides administrative/clerical support to the FCR team.Acts as a liaison, gather information and track all patients referred to the care management programsWork with the Operations Specialist and Senior Manager on projects as assigned.Monitor specific queues/workstreams and generates pre-defined reports to identify and resolve common errors. Your Knowledge and Experience Requires a high school diploma or equivalentRequires at least 5 years of prior relevant experienceRequires health insurance/managed care experienceRequires strong computer navigation skillsRequires independent motivation and strong work ethic
Full Time
6/2/2025
Oxnard, CA 93033
(19.0 miles)
Earn a $2,000 Completion Bonus!Epic Special Education Staffing is offering up to $2,000 as a Completion Bonus for Speech-Language Pathologists (SLPs) who complete their full assignment.ABOUT USTogether, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community. From our family to the nation’s schools, we remain focused on providing a world of opportunities for you to leverage your abilities and make an impact on special education. Apply today!POSITION DESCRIPTIONEpic Special Education Staffing is partnering with an exceptional school district who is looking for a contract School Speech Language Pathologist Assistant for the 2025 - 2026 school year.·Duration: 08/15/2025 - 06/18/2026·Location: Oxnard, CA·Location Type: On-Site·Schedule: Full Time·Hours: 40.00·Grade/Age Levels: Elementary School;Kindergarten;Pre-K·Weekly Pay Range: $36.00 – $41.40 per hour on a local contractBENEFITSWe offer a variety of benefits for you and your loved ones. As a valued and respected part of the Epic family, you will enjoy:·Competitive compensation packages for both local and travel contracts·Medical, Dental, and Vision benefits·Infertility & Domestic Partner Coverage·Summer Insurance Coverage·PTO & Holiday Pay·401K matching·Wellness and Employee Assistance Program (EAP)·CEU & license reimbursements·Referral bonuses of $1000QUALIFICATIONSThe minimum qualifications for School Speech Language Pathologist Assistant:·1 year of verifiable, professional experience as School Speech Language Pathologist Assistant within the last 3 years (may include residency or clinical practicum)·Valid School Speech Language Pathologist Assistant credential/license or in process in state of practice·Employees must be legally authorized to work in the United States and will be asked for proof upon hire. We are unable to sponsor or take over sponsorship of an employment Visa at this time.·We will consider all qualified applicants for employment, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws.·Epic Staffing Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, housing, age, disability or genetics.At Epic Special Education Staffing, you will have the opportunity to apply your unique experience and expertise with school-based special education as your singular focus. We offer stimulating and rewarding careers that provide an opportunity to make a difference in a child's life! Earn more for referring your friends! For a limited time, we are increasing our Referral Bonus for select positions! You could receive up to $2,250 bonus and a $250 charitable contribution! Submit your referrals by October 31, 2025, and ensure your friend begins their contract during the 2025-2026 school year to qualify.By applying for this position, you agree that any calls from Epic Staffing Group and its subsidiaries may be monitored or recorded for training and quality assurance purposes.
Full Time
6/10/2025
Pasadena, CA 91105
(39.5 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 $57.61 - $64.81 / Hour depending on qualifications and experience.Department:777001 O/P RehabExpectations:Evaluates, plans and administers treatment for disabilities, injuries and diseases in accordance with a physician's order. Responsible for coordination of care to meet identified Occupational Therapy needs of the patient/family; participates in the management of patient care to include identification of needs of Occupational Therapy intervention, discharge planning, resource identification, linking and scheduling patients with required services, monitoring care delivery, advocating for the patient, and evaluating outcomes, facilitating patient care across the health care continuum, and assists other team members with meeting patient needs. Is preceptor for related staff and students. Requires California State Occupational Therapist License.This is a per diem position which may require flexibility of hours and is eligible for overtime pay.EDUCATION:Graduate of an educational program for occupational therapists approved by the California Board of Occupational Therapy and accredited by the American Occupational Therapy Association’s Accreditation Council for Occupational Therapy Education (ACOTE).EXPERIENCE/TRAINING:Determined by patient care area. Minimum of one year related practice experience preferred.LICENSES/CERTIFICATIONS:Required:Current unrestricted Occupational Therapist License issued by California Board of Occupational Therapy (CBOT)Current Occupational Therapist Registered (OTR) issued by National Board for Certification in Occupational Therapy (NBCOT)Current Physical Agent Modalities (PAM) Certification issued by State of California for working with modalities: specialized hand diagnoses patients, pediatrics, dysphagiaCurrent Basic Life Support Provider (BLS) issued by American Heart AssociationSKILLS:Successful completion of orientation.Worker Type:Per DiemPart timeShift:Days
Full Time
6/2/2025
Oxnard, CA 93036
(21.7 miles)
Overview: Clinic Director - Certified Occupational Therapy Assistant (COTA)Make the Best Investment in Your CareerWhy is EmpowerMe different We believe in therapists. That’s why we invest so heavily in their success with extensive training, free CEUs, mentoring, and most importantly, a variety of paths for professional growth. Come build a future with us!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 Certified Occupational Therapy Assistant (COTA) to serve as Clinic Director at 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 Clinic Director, you will be responsible for:Overseeing how team members at your location(s) deliver care in accordance with federal, state, and local regulations Leading operational initiatives, including the implementation of company-wide policies, clinical programs, and quality initiativesCollaborating with interdisciplinary care partners on treatment planning and therapeutic interventionsMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesAs a COTA, you will be responsible for: Providing occupational therapy and wellness services for older adults under the supervision of an OTContributing to program development, quality improvement, and problem-solvingAssisting 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 Occupational Therapy Assistant program (New Grads Welcome) Current COTA 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 - $45.00 per hour
Full Time
6/10/2025
Long Beach, CA 90899
(43.7 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
6/10/2025
Pasadena, CA 91105
(39.5 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 $66.19 - $74.67 / Hour depending on qualifications and experience.Department:764000 Rad-TherapeuticExpectations:Under limited supervision and as assigned by the Chief Radiation Therapist, provides daily treatment for cancer patients. Positions and adjusts equipment for proper daily dose and operations. Records necessary information pertaining to daily treatment and patient concerns. Maintains assigned work area in a neat and orderly fashion. Use of computers a must. This position may require flexibility of hours.EDUCATION:AA Degree or Graduate from an approved AMA school of Radiation Therapy TechnologyEXPERIENCE/TRAINING:Minimum 2 years experience as Radiation Therapist working in the field preferred. High dose rate brachytherapy experience preferred. Graduate of an accredited School of Radiation Therapy Technology.LICENSES/CERTIFICATIONS:Required:Current Certified Radiologic Technologist (CRT) issued by California Department of Public Health (CDPH)Certified Radiologic Technologist (CRT) Fluoroscopy Permit issued by California Department of Public Health (CDPH)Current Basic Life Support Provider (BLS) issued by American Heart AssociationPreferred:Current American Registry of Radiologic Technologists (ARRT) certification issued by the American Registry of Radiologic TechnologistsSKILLS:Knowledge of computers, anatomy, physiology, linear accelerators, simulators, high dose rate brachytherapy, moderate understanding of treatment planning, knowledge of equipment, body mechanics, isolation procedures and standard precautions.Worker Type:Per DiemPart timeShift:Days
Full Time
6/10/2025
Los Angeles, CA 90232
(26.5 miles)
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 - $45.00 per hour
Full Time
6/10/2025
Long Beach, CA 90899
(43.7 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
(39.5 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
6/10/2025
Long Beach, CA 90899
(43.7 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
(39.5 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
(43.7 miles)
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
Full Time
6/10/2025
Long Beach, CA 90899
(43.7 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
(43.7 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
6/10/2025
Long Beach, CA 90899
(43.7 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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