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Full Time
6/10/2025
Oakland, CA 94616
(1.6 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
6/19/2025
San Jose, CA 95199
(40.5 miles)
Job DescriptionNomad Health seeks an experienced Labor & Delivery registered nurse for a travel assignment in CA.Take the next step in your healthcare career and join Nomad Health as a Labor & Delivery travel nurse. As a traveler with Nomad, you get access to industry-leading pay, outstanding benefits, and our knowledgeable Nomad Navigator support team.QUALIFICATIONSMinimum one year of RN experienceOne yearLabor & Delivery experience within the last two years as an RNHave an active RN license or be willing to obtain a Registered Nurse license in CARN degree from an accredited registered nurse programBLS and all relevant Labor & Delivery/department-specific certifications requiredRegister for a Nomad Health account to view full job details and applyNOMAD BENEFITSMajor medical and dental plans available on your first day of work401(k) with employer matching availableReimbursement for travel to your assignmentHousing stipendWeekly deposits direct to your bank accountWe work with thousands of travel nurses all over the country, in a wide variety of specialties and disciplines. To apply as a travel RN with us, you must have an active Professional Registered Nursing License or be willing to obtain one in the state you’re applying to, evidence of a minimum of one year RN work experience, and evidence of at least one year of Labor & Delivery experience within the last two years. In addition, you must have a Bachelor’s or Associate degree in nursing from an accredited registered nursing program, as well as a Basic Life Support (BLS) and all other relevant specialty/department certifications.At Nomad, we want to give you the tools you need to succeed. Our Nomad Navigators are passionate about helping you get to the bedside as quickly and efficiently as possible. They can help you with your application, credentialing, and finding housing. Our Navigators have experience working with travel nurses and can even help with on-the-job concerns if any arise while on assignment, and can provide clinician-to-clinician support.In addition to real hands-on support, we have a benefits package that was explicitly built for traveling clinicians and includes a housing stipend, partial travel reimbursement, and major medical and dental plans available on your first day of work. We also have a 401(k) program with employer matching options, a user-friendly digital timekeeping process, and weekly direct deposits.With your Nomad Health account, you get access to our unique digital platform; a platform built to help you land your perfect assignment. Move your travel healthcare career forward and find your next job today.We are seeking experienced RNs in a number of specialties to fill critical roles across the country: Medical Surgical NurseEmergency Room NurseStep-Down NurseTelemetry NurseICU NurseOperating Room NurseLabor and Delivery NurseCath Lab NursePsychiatric NurseAnd more travel RN jobs!
Full Time
6/10/2025
San Francisco, CA 94112
(10.1 miles)
Overview: Certified Occupational Therapy Assistant (COTA) - SNFYour 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! Responsibilities: The OpportunityWe are hiring a Certified Occupational Therapy Assistant (COTA)to join our team and work with the residents of askilled nursing care facility (SNF) that may offer rehab-to-home or long-term care settings. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part A.As a COTA, you will be responsible for:Providing occupational therapy and wellness services for older adults under the supervision of a OTMaintaining 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 accreditedOccupational Therapy Assistantprogram (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: $36.00 - $45.00 per hour
Full Time
6/1/2025
San Francisco, CA 94109
(6.9 miles)
Radiology Technologist - Electrophysiology (EP) LabWe are seeking a highly skilled Radiology Technologist specializing in Electrophysiology (EP) Lab procedures. In this role, you will assist in diagnostic and interventional procedures related to cardiac arrhythmias, ensuring accurate imaging and patient safety throughout the process.Key Responsibilities:Prepare patients for EP procedures by explaining the process, obtaining consent, and ensuring their comfort.Monitor and record electrocardiograms (ECGs) and intracardiac signals during EP procedures.Operate imaging equipment to guide physicians during diagnostic or interventional procedures.Ensure compliance with radiation safety protocols to protect patients and staff from unnecessary exposure.Maintain accurate records of patient data and procedure details.Respond to medical emergencies within the EP lab, including providing basic life support (BLS) or advanced cardiac life support (ACLS).Work Environment:Work in hospitals or specialized electrophysiology labs equipped with advanced imaging technology.Collaborate closely with physicians, nurses, and other healthcare professionals in a high-pressure environment.Benefits:A competitive salary with a comprehensive benefits package.Access to cutting-edge technology and ongoing training opportunities in electrophysiology procedures.A supportive work environment that values teamwork and innovation in patient care delivery systems.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*
Full Time
6/10/2025
Oakland, CA 94616
(1.6 miles)
Your Role The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment, planning, implementation, and evaluation of the Member’s Care Plan. The Licensed Clinician, Senior will report to the Manager, Behavioral Health Utilization Management. In this role you will be working with both the Utilization and Care Management teams, who provide utilization management, telephonic triage and care management assistance to members requesting access to Applied Behavioral Analysis (ABA) benefit. This role has a primary function of utilization management for our members seeking Behavioral Health Treatment (BHT).Your Work In this role, you will: Perform prospective utilization reviews and first level determination for members using BSC evidenced based guidelines, policies and/or nationally recognized clinal criteriaReview Functional Behavioral Assessments (FBA) and Board Certified Behavior Analyst (BCBA) Assessments submitted by providers for adherence to BACB “best practice” guidelinesGather clinical information and apply the appropriate clinical criteria/guideline, policy, and clinical judgment to render coverage determination/recommendation; prepare and present cases to Medical Director (MD) for medical director oversight and necessitydeterminationDevelop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriateAct as a liaison with caregivers, providers, and the health care community to provide information to regarding community treatment resources, mental health managed care programs, company policies and procedures, and medical necessity criteriaSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamYour Knowledge and Experience Master’s degree in psychology or a related fieldPossesses an active BCBA certificationAt least 5 years of experience as a BCBA • Expert knowledge of Applied Behavior Analysis and Autism Spectrum DisordersConsiderable knowledge of Managed Care and the different lines of businessDemonstrated ability to deliver training to varied audiences and conduct effective meetingsExperience in a managed health care environment with regards to BHT servicesAbility to identify problems and works towards problem resolution independently, seeking guidance as neededAbility to represent the health plan in a professional and knowledgeable fashionAbility to express ideas clearly in both written and oral communicationsAbility to develop, organize, analyze, and implement processes and proceduresProficiency with Microsoft applications including Word, Excel, Outlook, and TeamsEffective interpersonal skills
Full Time
6/19/2025
San Jose, CA 95199
(40.5 miles)
Job DescriptionNomad Health seeks an experienced Labor & Delivery registered nurse for a travel assignment in CA.Take the next step in your healthcare career and join Nomad Health as a Labor & Delivery travel nurse. As a traveler with Nomad, you get access to industry-leading pay, outstanding benefits, and our knowledgeable Nomad Navigator support team.QUALIFICATIONSMinimum one year of RN experienceOne yearLabor & Delivery experience within the last two years as an RNHave an active RN license or be willing to obtain a Registered Nurse license in CARN degree from an accredited registered nurse programBLS and all relevant Labor & Delivery/department-specific certifications requiredRegister for a Nomad Health account to view full job details and applyNOMAD BENEFITSMajor medical and dental plans available on your first day of work401(k) with employer matching availableReimbursement for travel to your assignmentHousing stipendWeekly deposits direct to your bank accountWe work with thousands of travel nurses all over the country, in a wide variety of specialties and disciplines. To apply as a travel RN with us, you must have an active Professional Registered Nursing License or be willing to obtain one in the state you’re applying to, evidence of a minimum of one year RN work experience, and evidence of at least one year of Labor & Delivery experience within the last two years. In addition, you must have a Bachelor’s or Associate degree in nursing from an accredited registered nursing program, as well as a Basic Life Support (BLS) and all other relevant specialty/department certifications.At Nomad, we want to give you the tools you need to succeed. Our Nomad Navigators are passionate about helping you get to the bedside as quickly and efficiently as possible. They can help you with your application, credentialing, and finding housing. Our Navigators have experience working with travel nurses and can even help with on-the-job concerns if any arise while on assignment, and can provide clinician-to-clinician support.In addition to real hands-on support, we have a benefits package that was explicitly built for traveling clinicians and includes a housing stipend, partial travel reimbursement, and major medical and dental plans available on your first day of work. We also have a 401(k) program with employer matching options, a user-friendly digital timekeeping process, and weekly direct deposits.With your Nomad Health account, you get access to our unique digital platform; a platform built to help you land your perfect assignment. Move your travel healthcare career forward and find your next job today.We are seeking experienced RNs in a number of specialties to fill critical roles across the country: Medical Surgical NurseEmergency Room NurseStep-Down NurseTelemetry NurseICU NurseOperating Room NurseLabor and Delivery NurseCath Lab NursePsychiatric NurseAnd more travel RN jobs!
Full Time
6/10/2025
Foster City, CA 94404
(17.8 miles)
Overview: Licensed Physical Therapist Assistant (PTA) - Care Coordination ProgramPhysical Therapy + Care Coordination: The Best of Both Worlds!We’re looking for Physical Therapy Assistants to support our innovative new care coordination program! This opportunity empowers you to practice at the top of your license, while giving you the chance to branch out into care coordination duties designed to standardize your hours and grow your career. All this plus truly flexible scheduling, amazing benefits, and the ability to make a huge difference in the lives of seniors!Incentive OpportunitiesFor some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The OpportunityWe are hiring a licensed Physical Therapist Assistant (PTA) to join our team and work with the residents of a senior living community that offers one or more of the following care settings: independent living, assisted living, and memory care. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part B. As a PTA, you will be responsible for: Providing physical therapy and wellness services for older adults under the supervision of a PT as part of a multidisciplinary teamSupport care coordination efforts by conducting regular wellness checkpoint visits with patients, communicating with patients’ providers and caregivers, and assisting patients with attending telehealth visitsMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesContributing to program development, quality improvement, and problem-solvingAssist with optimizing each patient’s functional well-being and satisfactionYour ScheduleWhile our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle!Our Amazing BenefitsAll Employees Get: Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind! 401(k) Eligibility with Opportunity for Matching FundsAmazing Career Advancement and Cross Training OpportunitiesRecognition ProgramsEmployee Assistance ProgramPart-Time Employees Also Get:Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Full-Time Employees Also Get:Full Benefits, including HSA, FSA, and Life & Disability InsuranceVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time Off Qualifications: You’re Our Perfect Fit If...You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a jobyou seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights.Plus, you have the following: Completion of an accredited Physical Therapy Assistant program (New Grads Welcome) Current PTA state licensure Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! Professional curiosity and a knack for finding solutionsCome be a part of our mission to make a positive impact on the lives of seniors. Apply today!About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $33.00 - $46.00 per hour
Full Time
6/13/2025
Oakland, CA 94621
(7.1 miles)
Physical Therapist - Home Health Join our team as a dedicated Physical Therapist in Home Health, where you will help patients improve movement, manage pain, and regain independence in the comfort of their own homes. Key Responsibilities: Review patient medical histories and conduct assessments to diagnose movement dysfunction and identify patient goals.Develop and implement individualized treatment plans that may include hands-on therapy, exercises, and use of assistive equipment.Provide skilled physical therapy services in accordance with a physician’s plan of care, adapting interventions to the home environment.Educate patients and family members about the recovery process, safe mobility, and home exercise programs.Monitor and document patient progress, modifying treatment plans as needed to achieve optimal outcomes.Communicate and collaborate with physicians, nurses, and other healthcare professionals to coordinate care.Supervise and instruct Physical Therapist Assistants or Aides as required.Ensure all documentation is completed promptly and accurately in compliance with agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires strong communication, organizational skills, and the ability to work independently. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance expertise in home health physical therapy. Equal Opportunity Employer: Your commitment to helping patients regain independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*
Full Time
6/10/2025
Oakland, CA 94616
(1.6 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
6/15/2025
San Jose, CA 95199
(40.5 miles)
Job DescriptionNomad Health seeks an experienced Neonatal ICU (NICU) registered nurse for a travel assignment in CA.Take the next step in your healthcare career and join Nomad Health as a Neonatal ICU (NICU) travel nurse. As a traveler with Nomad, you get access to industry-leading pay, outstanding benefits, and our knowledgeable Nomad Navigator support team.QUALIFICATIONSMinimum one year of RN experienceOne yearNeonatal ICU (NICU) experience within the last two years as an RNHave an active RN license or be willing to obtain a Registered Nurse license in CARN degree from an accredited registered nurse programBLS and all relevant Neonatal ICU (NICU)/department-specific certifications requiredRegister for a Nomad Health account to view full job details and applyNOMAD BENEFITSMajor medical and dental plans available on your first day of work401(k) with employer matching availableReimbursement for travel to your assignmentHousing stipendWeekly deposits direct to your bank accountWe work with thousands of travel nurses all over the country, in a wide variety of specialties and disciplines. To apply as a travel RN with us, you must have an active Professional Registered Nursing License or be willing to obtain one in the state you’re applying to, evidence of a minimum of one year RN work experience, and evidence of at least one year of Neonatal ICU (NICU) experience within the last two years. In addition, you must have a Bachelor’s or Associate degree in nursing from an accredited registered nursing program, as well as a Basic Life Support (BLS) and all other relevant specialty/department certifications.At Nomad, we want to give you the tools you need to succeed. Our Nomad Navigators are passionate about helping you get to the bedside as quickly and efficiently as possible. They can help you with your application, credentialing, and finding housing. Our Navigators have experience working with travel nurses and can even help with on-the-job concerns if any arise while on assignment, and can provide clinician-to-clinician support.In addition to real hands-on support, we have a benefits package that was explicitly built for traveling clinicians and includes a housing stipend, partial travel reimbursement, and major medical and dental plans available on your first day of work. We also have a 401(k) program with employer matching options, a user-friendly digital timekeeping process, and weekly direct deposits.With your Nomad Health account, you get access to our unique digital platform; a platform built to help you land your perfect assignment. Move your travel healthcare career forward and find your next job today.We are seeking experienced RNs in a number of specialties to fill critical roles across the country: Medical Surgical NurseEmergency Room NurseStep-Down NurseTelemetry NurseICU NurseOperating Room NurseLabor and Delivery NurseCath Lab NursePsychiatric NurseAnd more travel RN jobs!
Full Time
6/10/2025
Palo Alto, CA 94303
(26.6 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 - $46.00 per hour
Full Time
6/1/2025
Oakland, CA 94621
(7.1 miles)
Occupational Therapist - Home Health Join our team as a dedicated Occupational Therapist in Home Health, where you will help patients regain independence and improve their ability to perform daily activities in their own homes. Key Responsibilities: Assess patients’ functional abilities and develop individualized treatment plans to address self-care, mobility, and safety needs.Implement therapeutic interventions to improve patients’ ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs).Educate patients and caregivers on adaptive equipment, home modifications, and strategies to enhance independence.Monitor and document patient progress, adjusting treatment plans as needed to achieve optimal outcomes.Collaborate with physicians, nurses, and other healthcare professionals to coordinate care and support patient goals.Ensure timely and accurate documentation in compliance with agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires creativity, problem-solving skills, and the ability to work independently while supporting patients and families. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance expertise in home health occupational therapy. Equal Opportunity Employer: Your dedication to helping patients achieve independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*
Full Time
6/10/2025
Oakland, CA 94616
(1.6 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/never events. The Utilization Management Nurse, Seniorwill report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical documents and applying clinical criteria to establish the most appropriate level of care. This role will be focusing primarily on inpatient psych reviews for Residential Treatment and Detox. Also, you will be reviewing hospital itemized bills for a comprehensive line-by-line audit and manual claims processing on exceptions to ensure that appropriate billing practices are followed based on facility specific contract language. These exceptions may include medical necessity, DRG validation, stop loss, trauma, ER, burns, implants, NICU, transplants, hospital acquired conditions/never events and aberrant billing.Your Work In this role, you will: Perform retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEPConducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliancePrepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationand communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirementsDevelop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standardsandidentifypotential quality of care issues, service or treatment delays and intervenes or as clinically appropriateClearly communicates, is collaborative, while working effectively and efficientlyReview itemizations for coding logic using industry standards as well as CMS guidelinesTriages and prioritizes cases to meet required turn-around timesIdentifies potential quality of care issues, service or treatment delays as clinically appropriate.Clinical judgment and detailed knowledge of benefit plans used to complete review decisionsYour Knowledge and Experience Requires a bachelor's degree or equivalent experienceRequires a current California RN LicenseRequires at least 5 years of prior relevant experiencePrevious Inpatient Psych experience preferredRequires strong attention to detail to include ability to analyze claim data analyticsRequires independent motivation, strong work ethic and strong computer navigations skillsPsych claims review experience preferred
Full Time
6/10/2025
Palo Alto, CA 94303
(26.6 miles)
Overview: Certified Occupational Therapy Assistant (COTA)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! Responsibilities: The OpportunityWe are hiring a Certified Occupational Therapy Assistant (COTA) 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 COTA, you will be responsible for: Providing occupational therapy and wellness services for older adults under the supervision of a OTMaintaining 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 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 - $47.00 per hour
Full Time
6/10/2025
Oakland, CA 94616
(1.6 miles)
Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.Your Work In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as neededGather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationProvide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteriaWork with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed ManagerRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and Experience Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least five (5) years of prior experience in healthcare related fieldThree (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment requiredStrong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed
Full Time
6/13/2025
Santa Clara, CA 95054
(34.2 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 - $46.00 per hour
Full Time
6/10/2025
Oakland, CA 94616
(1.6 miles)
Your Role Reporting to the Manager, Care Management- Behavioral Health, the Behavioral Health Care Management Clinician, Seniorhelps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs. The Behavioral Health Care Manager will offer support in assessing members’ emotional and psychological well-being and providing resource coordination, crisis intervention, substance abuse, and with any behavioral or mental health referrals. The Behavioral Health Care Management Clinician, Senior will be available to physicians and nurse care managers as a consultant for patients with complex psychosocial needs. The position requires an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages.Your Work In this role, you will: Collaborate with case managers and other team members tocomplete member assessments related to social and resource needs tosupportmemberaccess to servicesCollaborate with service coordination staff and act as liaison to ensure a timely and accurate response to member needsCollaborate with providers to support members’ treatment plan and care needsRecognize the client’s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamAssessmembers health behaviors, cultural influences and clients belief/value systemand evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersEfficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness.Maintains an active workload in accordance with National Care Manager performance standards.Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases.Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independentlyAs a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.)Your Knowledge and Experience Current unrestricted CA License (LCSW, LMFT, LPCC, Registered Nurse (RN), or PsyD by the Board of Behavioral Health Sciences requiredAdvanced degree commensurate with field is preferredRequires at least five (5) years of prior relevant experience, including three (3) years of experience in behavioral health.Certified Case Manager preferredExperience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housingConsiderable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatmentProficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint
Full Time
6/13/2025
Santa Clara, CA 95054
(34.2 miles)
Overview: Certified Occupational Therapy Assistant (COTA)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! Responsibilities: The OpportunityWe are hiring a Certified Occupational Therapy Assistant (COTA) 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 COTA, you will be responsible for: Providing occupational therapy and wellness services for older adults under the supervision of a OTMaintaining 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 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 - $47.00 per hour
Full Time
6/10/2025
Oakland, CA 94616
(1.6 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
Cupertino, CA 95014
(36.7 miles)
Overview: Certified Occupational Therapy Assistant (COTA)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! Responsibilities: The OpportunityWe are hiring a Certified Occupational Therapy Assistant (COTA) 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 COTA, you will be responsible for: Providing occupational therapy and wellness services for older adults under the supervision of a OTMaintaining 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 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: $37.00 - $54.00 per hour
Full Time
6/10/2025
Oakland, CA 94616
(1.6 miles)
Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective, concurrent, retrospective utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Behavioral Health Utilization Management, Consultant (Lead), will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will support the clinicians with daily operations, provide coaching, and serve as the subject matter expert for the BH UM team as they conduct clinical reviews of mental health and substance use authorization requests at various levels of care for medical necessity.Your WorkIn this role, you will:Facilitate communication between leadership, Medical Directors, and non-clinical leads to address line staff questions and issues; escalate matters to management with recommendations or consultation as neededLead onboarding/training of incoming staff, provide proactive and guided support through the onboarding processMaintain and gain knowledge of behavioral health utilization management through team and departmental expansion as neededAct as subject matter expert to review and evaluate the effectiveness of operational workflows to identify problems and develop improvements, modifications, and enhancementsDevelop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staffAssist with audit readiness in collaboration with internal BSC partnersPerform advanced or complicated prior authorization and concurrent utilization reviews and first level determinations for members using non-profit association guidelines ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for oversight and necessity determinationIdentify process and control improvement opportunities and provide recommendations that help improve the effectiveness, efficiency and/or economic value of a control or processProvide guidance, coaching and training on internal behavioral health utilization management processes to other employees across the company as appropriateLead, manage, and execute other special projects and team initiatives as assignedLead team huddles/meetings to support processes and collaboration of team membersSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least seven (7) years of prior experience in healthcare related fieldExperience operating in a lead role or equivalent leadership training is preferredFive (5) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredDeep knowledge of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay clinical against nonprofit association guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed
Full Time
6/19/2025
Greenbrae, CA 94904
(16.5 miles)
Sonography - Echo Tech/Cardiac SonographerWe are seeking a skilled Cardiac Sonographer to join our team. In this role, you will use advanced ultrasound technology to create detailed images of the heart, assisting physicians in diagnosing and treating cardiovascular conditions.Key Responsibilities:Perform echocardiograms to assess heart function, including chamber size, valve function, and blood flow.Collaborate with physicians to analyze echocardiogram results and provide diagnostic support.Prepare patients for procedures by explaining the process and ensuring their comfort.Maintain and calibrate ultrasound equipment to ensure accurate imaging results.Document findings and maintain accurate patient records in compliance with healthcare standards.Assist with scheduling appointments and ensure proper cleaning of equipment after use.Work Environment:Work in hospitals, outpatient clinics, or diagnostic laboratories equipped with advanced imaging technology.Engage in a fast-paced environment requiring attention to detail and technical expertise.Benefits:A competitive salary with comprehensive benefits options available.Opportunities for professional growth through training and certifications in cardiac sonography.A supportive workplace culture focused on collaboration and innovation in patient care delivery systems.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*
Full Time
6/10/2025
Oakland, CA 94616
(1.6 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
Oakland, CA 94616
(1.6 miles)
Your Role The Care Managementteam will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Case Management – Nurse, Senior will report to the Manager of Care Management. In this role you will play a pivotal role in assessing member needs, providing clinical education, as well as care coordinationwith providers, medical groups, and community resources. You will be responsible for managing and coordinating patient care, ensuring that our members receive the highest quality of care and services. Care Managers perform care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.Your Work In this role, you will: Determine appropriateness of referral for CM services, mental health, and social servicesAssess members health behaviors, cultural influences and clients belief/value system. Evaluate all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. Adjust plans or create contingency plans as necessaryIdentify appropriate programs and services that align with member needs and preferencesInitiate timely Individualized Care Plans (ICP) based on Health Risk Assessment (HRA) completion, participation in and documentation of Interdisciplinary meetings (ICT), assisting in transitions of care across all agesProvide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental casesResearch opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipate potential barriers while establishing realistic goals to ensure success for the member, providers, and BSCDetermine realistic goals and objectives and provide appropriate alternatives. Actively soliciting client’s involvementRecognize need for contingency plans throughout the healthcare processProvide education and support to members and their families regarding health conditions, treatment options, and community resourcesFollow up with members as appropriate to ensure they have successfully connected with recommended programs and servicesYour Knowledge and Experience Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hireBachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires 5 years experience in nursing, healthcare, or related field A minimum of 3 years managed care experience in inpatient, outpatient, or managed care environment preferredHealth insurance/managed care experience preferredTransitions of care experience preferredStrong knowledge of healthcare delivery systems, managed care principles, and care coordinationExcellent communication skills
Full Time
6/10/2025
Greenbrae, CA 94904
(16.5 miles)
Sonographer - Ultrasound Technician Join our team as a skilled Sonographer (Ultrasound Technician), where you will play a critical role in providing diagnostic imaging that aids in patient care decisions. This position is ideal for professionals passionate about using advanced technology to deliver accurate diagnostic results. Key Responsibilities: Prepare patients for ultrasound procedures by explaining the process and addressing concerns.Operate specialized ultrasound equipment to capture images of internal organs and tissues for diagnostic purposes.Collaborate with physicians to interpret imaging results and ensure accurate diagnoses.Maintain detailed records of imaging procedures and ensure compliance with safety protocols.Inspect and maintain ultrasound equipment to ensure proper functionality during procedures. Work Environment: The role is based in hospitals, diagnostic imaging centers, or outpatient clinics equipped with state-of-the-art ultrasound technology.This position requires attention to detail in a fast-paced environment while adhering to strict safety standards for both patients and staff members. Benefits: A competitive salary with opportunities for career advancement within diagnostic imaging specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain certifications and expand expertise in sonography techniques. Equal Opportunity Employer: Your dedication to providing high-quality diagnostic imaging is valued here. We strive to create an inclusive environment where all employees can excel professionally while contributing meaningfully to patient care excellence. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*
Full Time
6/10/2025
Oakland, CA 94616
(1.6 miles)
Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Licensed Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members admitted to inpatient facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as neededGather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationProvide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteriaWork with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed ManagerRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and Experience Bachelor of Science or advanced degree preferredCurrent unrestricted CA license (LCSW, LMFT, LPCC, Licensed Psychologist, or Registered Nurse (RN) with Behavioral Health experience)Requires at least five (5) years of prior experience in healthcare related fieldThree (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredStrong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed
Full Time
6/1/2025
San Ramon, CA 94583
(19.2 miles)
Physical Therapist Assistant - Home Health Join our team as a dedicated Physical Therapist Assistant in Home Health, where you will work under the supervision of physical therapists to help patients regain movement and manage pain in their own homes. Key Responsibilities: Assist physical therapists in providing physical therapy treatments and procedures as outlined in the care plan.Observe and document patients’ status before, during, and after therapy, reporting progress and concerns to the supervising physical therapist.Help patients perform specific exercises and use therapeutic equipment safely in the home environment.Educate patients and family members about exercises and activities to continue between visits.Adapt interventions as needed within the scope of the treatment plan and state laws.Ensure all documentation is accurate and completed in a timely manner according to agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires strong interpersonal skills and the ability to work independently while supporting patient goals. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain certification and enhance expertise in home health physical therapy assistance. Equal Opportunity Employer: Your commitment to helping patients regain independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*
Full Time
6/10/2025
Oakland, CA 94616
(1.6 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/never events . The Manager, Utilization Management Nurse Management will report to the Senior Manager, Facility Compliance Review . In this role you will be responsible for several direct reports, be a resource for problem solving issues, training and updating documentation as needed. You will work to enhance the department’s operations with efficiency and attention to detail/quality.Your Work In this role, you will: Establish operational objectives for department or functional area and participate with other managers to establish group objectivesBe responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr ManagerDevelop and maintain FCR workflows, protocols, and policies to ensure efficient and effective care coordinationEnsure workflow procedures and guidelines are clearly documented and communicatedInterpret or initiate changes in guidelines/policies/proceduresMonitor and evaluate the performance of the FCR team and implement improvement strategies as neededKeeps team focused on specific and measurable performance goals and monitors performance against clear standards.Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomesProvide Ensure the delivery of high-quality, patient-centered care through the management of chronic disease, complex case management, and discharge planningOther duties as assigned by Sr ManagerYour Knowledge and Experience Requires a current CA RN LicenseBachelors of Science in Nursing or advanced degree preferred.Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program managerA minimum of 3+ year experience in inpatient or managed care environment preferredExcellent communication, interpersonal, and negotiation skillsHas functional expertise within the area of responsibility.Knowledge of NCQA requirements preferredAbility to analyze data and create reports to guide decision-making and process improvements
Full Time
6/19/2025
Vallejo, CA 94589
(23.7 miles)
Full Time
6/10/2025
Oakland, CA 94616
(1.6 miles)
Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional Registered Nurse Case Manager will report to the FEP Care Management Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needsYour WorkIn this role, you will:Coordinate care for lower level of care such Skilled Nursing Facility, Home Health, Home Infusion, Acute Rehab, Long-term Acute Care Hospital, Hospice, and other community program as appropriatePerform effective discharge planning and collaborate with member’s support system and health care professionals involved in the continuum of careProvides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease). Outreach to members with HEDIS Care Gaps to assist with closureApply detailed knowledge of FEP PPO and Blue Shield of California's established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each caseResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying withcontract for each appropriate plan typeProvide Referrals to QualityManagement (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamDesign appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomesInitiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsMust be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentationYour Knowledge and ExperienceRequires a current CA RN License.Bachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 5 years of prior experience in nursing, healthcare or related field3+ years managed care experience preferred.Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources preferredBehavioral health, oncology, or OB/NICU/pediatrics experience preferredStrong electronic clinical documentation skills, independent problem identification and resolution skillsKnowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirableCompetent understanding of NCQA and federal regulatory requirementsDemonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-makingDemonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care
Full Time
6/19/2025
Vallejo, CA 94589
(23.7 miles)
Full Time
6/19/2025
Oakland, CA 94616
(1.6 miles)
Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Experienced, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.Your WorkIn this role, you will:Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as neededGather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationProvide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteriaWork with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed ManagerRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least three (3) years of prior experience in healthcare related fieldOne (1) year conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredStrong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed
Full Time
6/1/2025
Redwood City, CA 94062
(25.3 miles)
Radiology Technologist - CT Scan TechWe are seeking a skilled Radiology Technologist specializing in CT Scans to join our team. In this role, you will operate advanced computed tomography (CT) equipment to produce detailed diagnostic images, ensuring high-quality care and accurate results for patients.Key Responsibilities:Prepare patients for CT scan procedures by explaining the process, answering questions, and positioning them correctly.Operate CT scan equipment to capture high-quality diagnostic images while ensuring patient safety and comfort.Administer contrast materials when necessary to enhance imaging results, following established safety protocols.Collaborate with physicians to analyze imaging results and provide accurate diagnostic support.Maintain and calibrate CT equipment to ensure optimal performance and compliance with safety standards.Document procedures and maintain accurate patient records in compliance with regulatory requirements.Work Environment:Work in hospitals, diagnostic imaging centers, or outpatient facilities equipped with advanced CT technology.Engage in a fast-paced environment requiring attention to detail and technical expertise.Collaborate with a multidisciplinary team dedicated to delivering exceptional patient care.Benefits:Competitive salary and comprehensive benefits package.Access to cutting-edge technology and ongoing training opportunities.A supportive work environment focused on professional growth and innovation.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*
Full Time
5/30/2025
Oakland, CA 94616
(1.6 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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