SEARCH
GO
Professional Jobs
Full Time
6/10/2025
Long Beach, CA 90899
(31.4 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
Encinitas, CA 92024
(44.8 miles)
Overview: SimVentions, consistently voted one Virginia's Best Places to Work, is looking for an experienced cybersecurity professional to join our team! As a Cybersecurity Engineer III, you will play a key role in advancing cybersecurity operations by performing in-depth system hardening, vulnerability assessment, and security compliance activities in accordance with DoD requirements. The ideal candidate will have a solid foundation in cybersecurity practices and proven experience supporting both Linux and Windows environments across DoD networks. You will work collaboratively with Blue Team, Red Team, and other Cybersecurity professionals on overall cyber readiness defense and system accreditation efforts.** Position is contingent upon award of contract, anticipated in December of 2025. ** Clearance: An ACTIVE Secret clearance (IT Level II Tier 5 / Special-Sensitive Position) is required for this position. Applicants selected will be subject to a security investigation and may need to meet eligibility requirements for access to classified information. US Citizenship is required to obtain a clearance. Requirements: In-depth understanding of computer security, military system specifications, and DoD cybersecurity policiesStrong ability to communicate clearly and succinctly in written and oral presentationsMust possess one of the following DoD 8570.01-M IAT Level III baseline certifications:CASP+ CECCNP SecurityCISACISSP (Associate)CISSPGCEDGCIHCCSP Responsibilities: Develop Assessment and Authorization (A&A) packages for various systemsDevelop and maintain security documentation such as:Authorization Boundary DiagramSystem Hardware/Software/Information FlowSystem Security PlanPrivacy Impact Assessmente-AuthenticationImplementation PlanSystem Level Continuous Monitoring PlanPorts, Protocols and Services RegistrationPlan of Action and Milestones (POA&M)Conduct annual FISMA assessmentsPerform Continuous Monitoring of Authorized SystemsGenerate and update test plans; conduct testing of the system components using the Assured Compliance Assessment Solution (ACAS) tool, implement Security Technical Implementation Guides (STIG), and conduct Information Assurance Vulnerability Management (IAVM) reviewsPerform automated ACAS scanning, STIG, SCAP checks (Evaluate STIG, Tenable Nessus, etc.) on various standalone and networked systemsAnalyze cybersecurity test scan results and develop/assist with documenting open findings in the Plan of Action and Milestones (POA&M)Analyze DISA Security Technical Implementation Guide test results and develop/assist with documenting open findings in the Plan of Action and Milestones Preferred Skills and Experience: A combined total of ten (10) years of full-time professional experience in all of the following functional areas:Computer security, military system specifications, and DoD cybersecurity policiesNational Cyber Range Complex (NCRC) Total Ship Computing Environment (TSCE) Program requirements and mission, ship install requirements, and protocols (preferred)Risk Management Framework (RMF), and the implementation of Cybersecurity and IA boundary defense techniques and various IA-enabled appliances. Examples of these appliances and applications are Firewalls, Intrusion Detection System (IDS), Intrusion Prevention System (IPS), Switch/Routers, Cross Domain Solutions (CDS), EMASS and, Endpoint Security Solution (ESS)Performing STIG implementationPerforming vulnerability assessments with the ACAS toolRemediating vulnerability findings to include implementing vendor patches on both Linux and Windows Operating systems Education: Bachelor of Science in Information Systems, Bachelor of Science in Information Technology, Bachelor of Science in Computer Science, Bachelor of Science in Computer Engineering Compensation: Compensation at SimVentions is determined by a number of factors, including, but not limited to, the candidate’s experience, education, training, security clearance, work location, skills, knowledge, and competencies, as well as alignment with our corporate compensation plan and contract specific requirements.The projected annual compensation range for this position is $90,000 - $160,000 (USD). This estimate reflects the standard salary range for this position and is just one component of the total compensation package that SimVentions offers. Benefits: At SimVentions, we’re committed to supporting the total well-being of our employees and their families. Our benefit offerings include comprehensive health and welfare plans to serve a variety of needs.We offer:Medical, dental, vision, and prescription drug coverageEmployee Stock Ownership Plan (ESOP)Competitive 401(k) programsRetirement and Financial CounselorsHealth Savings and Health Reimbursement AccountsFlexible Spending AccountsLife insurance, short- & long-term disabilityContinuing Education AssistancePaid Time Off, Paid Holidays, Paid Leave (e.g., Maternity, Paternity, Jury Duty, Bereavement, Military)Third Party Employee Assistance Program that offers emotional and lifestyle well-being services, to include free counselingSupplemental Benefit Program Why Work for SimVentions : SimVentions is about more than just being a place to work with other growth-orientated technically exceptional experts. It’s also a fun place to work. Our family-friendly atmosphere encourages our employee-owners to imagine, create, explore, discover, and do great things together.Support Our WarfightersSimVentions is a proud supporter of the U.S. military, and we take pride in our ability to provide relevant, game-changing solutions to our armed men and women around the world.Drive Customer SuccessWe deliver innovative products and solutions that go beyond the expected. This means you can expect to work with a team that will allow you to grow, have a voice, and make an impact.Get Involved in Giving BackWe believe a well-rounded company starts with well-rounded employees, which is why we offer diverse service opportunities for our team throughout the year.Build Innovative TechnologySimVentions takes pride in its innovative and cutting-edge technology, so you can be sure that whatever project you work on, you will be having a direct impact on our customer’s success.Work with Brilliant PeopleWe don’t just hire the smartest people; we seek experienced, creative individuals who are passionate about their work and thrive in our unique culture.Create Meaningful SolutionsWe are trusted partners with our customers and are provided challenging and meaningful requirements to help them solve.Employees who join SimVentions will enjoy additional perks like:Employee Ownership:Work with the best and help build YOUR company!Family focus:Work for a team that recognizes the importance of family time.Culture:Add to our culture of technical excellence and collaboration.Dress code:Business casual, we like to be comfortable while we work.Resources: Excellent facilities, tools, and training opportunities to grow in your field.Open communication:Work in an environment where your voice matters.Corporate Fellowship: Opportunities to participate in company sports teams and employee-led interest groups for personal and professional development.Employee Appreciation:Multiple corporate events throughout the year, including Holiday Events, Company Picnic, Imagineering Day, and more.Founding Partner of the FredNats Baseball team:Equitable distribution of tickets for every home game to be enjoyed by our employee-owners and their families from our private suite.Food:We have a lot of food around here!FTAC
Full Time
6/6/2025
Corona, CA 92883
(15.5 miles)
Extra attention to detail Exceptional outcomes This is a PRN position BE THE CONNECTION.Your role as a certified occupational therapy assistant (COTA) lets you be the connection between dedication to detail and patient outcomes that exceed expectations. Use your passion for rehabilitation to ensure that patients receive care that sets the standard as you treat patients with compassion and empathy. Enhance the impact of your abilities with national post-acute care leader Encompass Health. What Makes Encompass Health Careers Different-and Better:Working at Encompass Health means being part of something special: A team that is passionate about making an impact on patients' lives each day. Unlike the typical hospital setting, Encompass Health offers you the unique opportunity to walk alongside patients on their road to recovery from stroke, spinal cord injuries, neurological disorders, joint replacements, multiple trauma and cardiac/pulmonary conditions. As you help patients achieve goals and regain independence, you can form significant relationships with them and celebrate the successes they experience along the way.Our culture of compassion and collaboration is founded on more than just the care we provide our patients; it is expressed in the values we live. We encourage and empower each employee to keep learning and growing by providing the resources to deliver a better way to care. At Encompass Health, you'll find something decidedly different and more satisfying: A career that is challenging, inspiring and rewarding. Maximize your talent and join a team that is committed to setting the standard for better healthcare with this engaging opportunity: CERTIFIED OCCUPATIONAL THERAPY ASSISTANT (COTA)Here is your opportunity to channel the full extent of your knowledge, skills, ambition, and experience on a daily basis. Inspire our patients to progress each day as you:• Provide occupational therapy treatment and patient care according to hospital, state and federal regulations and professional guidelines.• Perform occupational therapy treatment tasks as delegated and supervised by occupational therapists.• Maintain open and ongoing communication with hospital departments to ensure that patient, staff and hospital needs are met. Credentials:• Current state licensure or certification or state practice act, whichever is applicable, required.• CPR certification preferred, unless otherwise required by hospital policy.• Successful completion of an associate's degree from an accredited occupational therapy assistant program preferred.• Effective communication skills for working with patients, families and caregivers required.• Demonstrated competency in occupational treatment essential. Enjoy competitive compensation and benefits that start on day one, including: • Benefits that begin when you do.• Affordable medical, dental and vision plans provided to meet the needs of full and part-time employees and their families.• Generous paid time off that increases with tenure.• Tuition reimbursement and continuing education opportunities.• Company-matching 401(k) and employee stock-purchase plans.• Flexible spending and health savings accounts. About Us:Helping patients regain hope and independence, Encompass Health is a national leader in post-acute care. We operate rehabilitation hospitals and offer home health and hospice care in 36 states as well as Puerto Rico. Following the Encompass Way, we are driven by our core values: We proudly set the standard, lead with empathy, do what's right, focus on the positive, and remain stronger together. Realize the powerful difference you can make. Take this opportunity to join our team.To learn more about us, please visit us online at encompasshealth.com Connect with us:Equal Opportunity Employer QualificationsCompensation: $45.00 an hour
Full Time
6/10/2025
Long Beach, CA 90899
(31.4 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
(31.4 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
5/31/2025
Murrieta, CA 92563
(29.6 miles)
Physical Therapist Assistant Career Opportunity Join a Team That Puts Your Passion for Care FirstAre you on the lookout for a fulfilling career that not only feels like home but also allows you to make a meaningful impact close to your heart Join us as a Physical Therapist Assistant and contribute to the remarkable progress and inspiring outcomes of our patients. Embrace the opportunity to deliver high- quality, compassionate, and personalized care, celebrating the small successes that lead to significant achievements in rehabilitation. Our well-equipped physical therapy gyms, driven team members, and supportive environment create an atmosphere where you can thrive. A Glimpse into Our WorldAt Encompass Health, you'll experience the difference the moment you become a part of our team. Being associated with us means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing. Starting Perks and BenefitsAt Encompass Health, we are committed to creating a supportive, inclusive, and caring environment where you can thrive. From day one, you will have access to: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.Opportunities for tuition reimbursement and continuous education.Company-matching 401(k) and employee stock purchase plans.Flexible spending and health savings accounts.A vibrant community of individuals passionate about the work they do!Be the Physical Therapist Assistant you always wanted to beChannel your expertise, ambition, and experience into making a difference every day:Provide top-notch physical therapy treatment in compliance with regulations and professional guidelines.Execute delegated physical therapy assistant tasks under supervision, supporting patients' progress.Maintain transparent communication across hospital departments to meet patient and staff needs effectively.QualificationsState licensure or certification required.CPR certification preferred (as per hospital policy).Completion of an accredited physical therapy program preferred.Demonstrated competence in physical therapy treatment.Strong communication skills for patient, family, and caregiver interactions. 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
6/6/2025
Long Beach, CA 90802
(32.2 miles)
YourRole TheCareManagement Department is seeking adedicated and compassionate Clinical Service Coordinator (CSC) to join our team.The Clinical Service Coordinatorwill report to the SupervisorofCare Operations.The CSC will play a vital role in outreach and engagement efforts with our members, introducing them to care management services, and conducting assessments to identify their needs. The successful candidate willinteract telephonically with members to assist with simple care coordination needs and facilitate connections between members and appropriate services, including internal nurse care managers, vendors, and behavioral health providers.YourWork Inthisrole,youwill:Conduct telephonic outreach efforts to engage members andintroduce them to care management services.CompletethoroughassessmentstoidentifymemberneedsandcaregapsMaintain accurateand up-to-datememberrecordsanddocumentation ofall interactions and services providedConductfollow-upcallstoensuremembers’needsarebeingmetProvide members with information and resources about available care management services and how to access themProvidesadministrative/clericalsupporttomedicalanddiseasemanagementprograms.Acts as aliaison, gathers information, and track all patients referred to the care management programs.Assists in coordinating care for specific high risk/high-cost patient population, including referrals tocommunity resources, facilitation ofmedical services, referral to ancillary providers,etc.Assistsinverifyinghealthplanbenefitsandcoordinatingambulatoryservices.Demonstratesculturalcompetencetoworkeffectively,respectfully,andsensitivelywithin the client’s cultural context.Assistswithpreceptingresponsibilitiesfornewhiresandauditingefforts. YourKnowledgeandExperience AminimumofahighschooldiplomaAminimumof3yearsofrelevantexperienceAminimumof1yearexperienceinamanagedcareenvironment.Bi-Lingual: Must be fluent in English and SpanishHealthinsurance/managedcareexperience(Commercial,Medicare,andMedi-Cal)CommunityresourcesandadvocacyAbilitytoidentifyissuesanddevelopeffectivesolutionstomeetmembers'needsFlexibilitytoadjusttochangingcircumstancesandmemberneedsStrong verbal and written communication skills to effectively convey information to members and colleagues
Full Time
6/10/2025
Long Beach, CA 90899
(31.4 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
◁   Previous
This website uses cookies for analytics and to function properly. By using our site, you agree to these terms.