Respiratory Therapist - ICUWe are seeking a skilled and compassionate Respiratory Therapist to join our Intensive Care Unit (ICU) team. In this role, you will provide critical respiratory care to patients with severe breathing disorders or life-threatening conditions, ensuring optimal outcomes through advanced therapeutic interventions.Key Responsibilities:Assess, treat, and monitor patients with acute or chronic respiratory conditions in the ICU setting.Initiate and manage mechanical ventilation and other life-support systems for critically ill patients.Administer aerosol medications, oxygen therapy, and other respiratory treatments as prescribed.Perform diagnostic tests such as arterial blood gas analysis and pulmonary function testing to evaluate lung performance.Collaborate with physicians, nurses, and other healthcare professionals to develop and implement individualized care plans.Respond to emergency situations, including rapid response or code blue events, to provide airway management and support.Maintain accurate patient records and document all treatments and progress in compliance with hospital policies.Educate patients and families on respiratory care techniques and equipment use when transitioning out of the ICU.Work Environment:Work in a fast-paced ICU environment that requires critical thinking and quick decision-making skills.Collaborate closely with a multidisciplinary team dedicated to providing life-saving care.Be prepared for rotating shifts, including nights, weekends, and holidays, as required in critical care settings.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through specialized training and certifications in critical care.A supportive work environment that values teamwork and innovation in patient care delivery.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Speech-Language Pathologist - OtherWe are seeking a versatile Speech-Language Pathologist to join our team. In this role, you will assess and treat individuals with diverse communication and swallowing disorders in various settings, helping them improve their quality of life.Key Responsibilities:Evaluate patients to identify speech, language, or swallowing difficulties.Develop and implement individualized treatment plans tailored to specific needs.Provide therapy focused on articulation, fluency, voice quality, and cognitive-communication skills.Educate patients and families on strategies to support communication and swallowing improvements.Collaborate with other healthcare professionals to ensure comprehensive care.Document patient progress and adjust therapy plans as needed for optimal outcomes.Work Environment:Work in varied environments such as private practices, hospitals, or community health programs.Engage in a dynamic setting requiring adaptability and innovative problem-solving skills.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through training and certifications.A supportive work environment focused on collaboration and innovation in patient care.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Occupational Therapist Join our team as an Occupational Therapist, where you will help individuals regain independence and improve their quality of life through customized therapeutic programs. This role is ideal for professionals passionate about empowering patients to overcome physical, emotional, or developmental challenges. Key Responsibilities: Evaluate patients' conditions and develop individualized treatment plans to address their needs.Plan and implement rehabilitative programs to improve daily living, vocational, and homemaking skills.Utilize therapeutic techniques, adapt environments, and modify tasks to overcome barriers to independence.Collaborate with patients, families, and other healthcare professionals to optimize care outcomes.Educate patients and caregivers on exercises, therapies, and strategies for continued progress outside the clinical setting.Document patient progress and adjust treatment plans as necessary. Work Environment: Work in diverse settings such as hospitals, outpatient clinics, schools, or patients' homes.Engage in a dynamic environment that may require standing for extended periods or assisting clients with mobility challenges. Benefits: Competitive salary with opportunities for professional growth.Comprehensive health, dental, and vision insurance plans.Retirement savings plan with employer contributions.Access to continuing education programs and certifications. Equal Opportunity Employer: We are committed to fostering a diverse and inclusive workplace where all employees feel valued and supported in their professional journey. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Physical Therapist - OtherWe are seeking a versatile and skilled Physical Therapist to join our team. In this role, you will provide specialized physical therapy services tailored to unique patient populations or settings, helping individuals improve mobility, manage pain, and regain independence.Key Responsibilities:Evaluate patients to determine their physical therapy needs and create individualized treatment plans.Implement therapeutic exercises, manual therapy techniques, and other interventions to address patients' specific conditions.Educate patients and caregivers on exercises, lifestyle changes, and techniques to promote recovery and prevent future injuries.Collaborate with other healthcare professionals to ensure comprehensive patient care.Document patient progress and adjust treatment plans as necessary to achieve optimal outcomes.Adapt therapy approaches based on the unique requirements of the setting or patient population.Work Environment:Provide care in diverse settings such as home health, schools, community programs, or specialized facilities.Work in a dynamic environment requiring adaptability and innovative problem-solving skills.Collaborate with multidisciplinary teams to deliver holistic care tailored to individual needs.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through specialized training and certifications.A supportive work environment focused on collaboration and innovation in patient care.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Middle Market underwriting team is responsible for balancing operating income and membership goals while protecting the company’s bottom line from loss. The Underwriter - Large Group, Experiencedwill report to the group underwriting manager. In this role you will directly contribute to the company achieving its financial and strategic goals for employer accounts with 101 or more eligible subscribers. Your Work In this role, you will: Collect, review and analyze customer specific information including financial condition, employee demographics, carrier history and previous claim experience to determine risk, potential benefit features and premium rates for fully insured groups requiring minimal customizationUnderwrite new and renewal business by calculating monetary risk along with amendments to existing contractsAssist as necessary in the negotiation of benefit plan designs and financial assumptions with sales teams on new and renewed businessReview and approve all sales requests within company established standards and policy guidelinesReview and interpret ad hoc reports as requested and produce ongoing reportsMay assist the sales team in implementing new and existing contracts by reviewing final enrollment numbersProvides underwriting knowledge sharing and education to peers and/or members of the sales teamYour Knowledge and Experience Requires a bachelor's degree in a related field such as finance, mathematics or accounting and/or equivalent combination of education and experienceRequires at least 3 years of prior relevant experienceRequires working knowledge of underwriting principles and proceduresRequires demonstrated math/statistical, analytical and problem-solving skillsRequires an attention to detail and accuracy and understanding of the company’s revenue, operating income and membership goalsRequires ability to solve complex problems with sometimes ambiguous informationRequires good time management and customer service skills

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.*

Your Role The Network and Trend Analytics team drives the development of an affordable provider network through data analytics and expertise. The Experienced Actuarial Analyst will report to the Senior Principal and will perform actuarial analysis primarily supporting the Behavioral Health provider network.Your Work In this role, you will: Understand the core principles and functionality of decision, descriptive, predictive and prescriptive analytic methods including forecasting, statistical and machine learning techniquesConduct and develop analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and/or evaluates actuarial risk related analysisCoordinate, prepare, perform and audit actuarial analyses to assist in the development of complex actuarial formulations leading to the recommendation of pricing, trending, reserving, provider reimbursement and/or risk assessment strategiesPerform data exploration using a combination of statistical programming languages (including, but not limited R, Python, SQL, SAS) and deploy predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficienciesDirect, coordinate, and/or develop evaluation and financial reporting standards for internal and external reportsUnderstand and accurately track the unit cost trend, support database upgradeGenerate reports and analysis from unit cost tracking database, respond to requests from inside and outside of the teamYour Knowledge and Experience Requires a bachelors degree with at least a minor in mathematics, statistics, computer science or equivalent business experienceRequires at least 2 years of professional actuarial experienceRequires proficiency in Excel and AccessPrefers proficiency in VBA and SAS

Your Role The End-to-End Member Experience team is responsible for developing a comprehensive Member Experience (MX) strategy that integrates digital, call center, marketing, and operations efforts to achieve excellence within the healthcare industry. The End-to-End Member Experience Strategic Insights, Consultant will report to the Senior Manager, Strategic Insights for End-to-End Member Experience. In this role, you will design, manage, and conduct MX research in collaboration with external vendors and internal stakeholders to inform the optimization of member experiences specific to Blue Shield members, all while driving our Net Promoter Score (NPS) and Forrester program performance.Your WorkIn this role, you will:Drive MX strategy by generating insights to prioritize and refine the MX roadmap, focusing on initiatives to enhance the experience for all membersSynthesize complex data and concepts into easily understood stories and recommendations for senior leadership and cross-functional teams, by scaling our NPS and Forrester programsSupport the Voice of the Customer (VoC) programs and collaborate across the organization to translate member reported issues into effective actionable resultsDerive insights and trends from data and analytics to create high-level strategies to drive optimization of customer experience and enhancement of loyaltyIdentify critical short and long-term business opportunities that enable transformational change across the enterpriseSynthesize complex data and concepts into easily understood stories and recommendations for senior leadership, by scaling our NPS & Forrester programsProduce impactful insights by leveraging expertise in survey design, statistical analysis, and data-driven storytellingCollaborate with internal teams to leverage insights in the development of journey maps and action plansNavigate ambiguity through strategic thinking, identify and implement improvements to various processes, programs, and tools used in support of the VoC best practicesOwn monthly, quarterly, and annual reporting, sharing insights in presentations to internal teamsYour Knowledge and ExperienceRequires a bachelor’s degree or equivalent experience and/or equivalent combination of education and experienceRequires at least 7 years of prior relevant experience, including in Member or Customer Experience, Voice-of-Customer programs (e.g., CAHPS, Digital MSAT, NPS, Forrester, etc.) or Market ResearchRequires ability to analyze ambiguous feedback from members/customers, employees, and other sources to turn into actionable insights for practical useRequires experience with tools to analyze and interpret member feedback data (e.g., Tableau, Vendor managed software, etc.)Requires experience with applying a variety of data analysis techniques and combining survey and operational dataExperience in customer experience program reporting, design, and roadmap development, in roles such as analyst, program manager, or adjacent strongly preferredExperience managing customer experience improvement projects from insights to building business cases to managing implementation (working with cross-functional teams), strongly preferredStrong communicator, self-starter, strategic thinker with a blend of business understanding and quantitative skills#LI-AD3