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

Description & Requirements Description Sign-On Bonus: $500 Compensation:$26 - $32 Per Hour - Full time, based upon experience Promotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare: Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience: Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA, Program Management,and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob Description Intercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking Behavioral Program Managerswho share our passion for improving the lives of children and families affected by autism. A Behavioral Health or (ABA)Program Manager serves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, and able to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor! Learn more about us on You Tube! This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health. Closing: If you have experience in any of the following fields, we encourage you to apply: Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBA Intercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance. Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Description RN Care Manager for our Care Management Team at Providence Saint Johns Health Center in Santa Monica, CA. This position is Full-Time and will work 8-hour Day shifts. Case Management is a collaborative practice including patients, caregivers, nurses, social workers, physicians, payers, support staff, other practitioners and the community. The Case Management process facilitates communication and care coordination along a continuum through effective transitional care management and utilization management. Recognizing the patient's right to self-determination, the significance of the social determinants of health and the complexities of care. Providence Saint John's Health Center, recognized as one of the best regional hospitals in 17 types of care by U.S. News & World Report and honored by Newsweek and Healthgrades for exceptional clinical quality. Be a part of our distinguished team dedicated to excellence in patient care. We are on the Magnet journey, and we were just awarded a 5-star rating for quality, safe care from the Centers of Medicare and Medicaid Services (CMS). Providence caregivers are not simply valued – they’re invaluable. Join our team at Saint Johns Health Center and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: Bachelor’s Degree in Nursing or equivalent educ/experienceEquivalent educ/experience: All Registered Nurses without a minimum of a Bachelor’s degree in Nursing must obtain a Bachelor’s degree in Nursing or higher within 3 years of hire.Upon hire: California Registered Nurse License2 years experience in Healthcare related field (Acute, Ambulatory, Post-Acute, etc.)2 years experience in Case Management (Care Coordination or Utilization Management) or successful completion of the Transitions in Practice (TIP) program for Care Manager. TIP candidates must have experience in same type of nursing unit in which the CM position is available. Preferred Qualifications: Master's Degree in Nursing or Healthcare related fieldUpon hire: Certification in Case Management (ACM or CCM) Why Join Providence Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Requsition ID: 367590 Company: Providence Jobs Job Category: Care Management Job Function: Clinical Care Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 7006 PSJHC CASE MGMT Address: CA Santa Monica 2121 Santa Monica Blvd Work Location: Providence Saint John's Health Ctr-Santa Monica Workplace Type: On-site Pay Range: $56.44 - $87.63 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

The pay range per hour is $25.00 - $42.50Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at .ALL ABOUT TARGETWorking at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. ALL ABOUT GENERAL MERCHANDISEExperts of operations, process and efficiency who enable a consistent experience for our guests by ensuring product is set, merchandised and available, accurately priced and signed on the sales floor. The General Merchandise and Food Sales team leads inbound, outbound, replenishment, and promotional signing processes for all General Merchandise (GM) areas of the store. This team also leads inventory accuracy, merchandise set-up and pricing processes for all areas of the store. This team may also lead Food & Beverage and Food Service, providing a fresh and food safe experience. Experts enable efficient delivery of merchandise to our guests by owning pick, pack and ship fulfillment work. At Target, we believe in our leaders having meaningful experiences that help them build and develop skills for a career. The role of a General Merchandise Team Leader can provide you with the skills and experience of: Guest service fundamentals and experience building a guest first culture on your teamRetail business fundamentalsincluding: department sales trends, inventory management, guest shopping patterns, pricing and promotions strategies Leading a team by planning department(s) daily/weekly workload to support business priorities and deliver sales goals, with alignment from your direct leader, all while driving process improvements and enhancing workload efficiency.Leading a team of hourly team members; including skills in interviewing, developing, coaching, evaluating and retaining talent.Coaching and traininghourly team members to build a team of hourly team members with direction from your direct leaderAs a General Merchandise Team Leader, no two days are ever the same, but a typical day most likely willinclude the following responsibilities:Execute daily/weekly workload to deliver on department and store sales goals and guest engagement, including: merchandising, pricing, setting and updating merchandise salesfloor displays, sampling, promotions and price change.With guidance from your leader, educate your team on how operational procedures, such as setting up and organizing merchandise, managing product stock levels, and maintainingsales floor areas, affect inventory management, store profitability, and product availability.Help assess reporting to identify gaps in GM processes and assist to develop a plan to resolve for your direct leader to review and approve. Be an expert of operations, accuracy, process and efficiency.With your direct leader's guidance, assist with and lead the daily execution of tasks such as receiving products, restocking shelves, organizing the backroom, arranging merchandise, and putting up promotional signs for GM areas.With your direct leader’s guidance, assist and lead with the processes in inventory accuracy, merchandise set-up and maintenance, and pricing for all areas of the store.Assign daily tasks to TMs based on planned workload and guest traffic patterns, ensuring alignment with weekly and monthly business priorities set by your leader.With your direct leader’s guidance, help establish clear goals and expectations and hold team members accountable to expectations.With your direct leader’s guidance, help with efficient delivery to our guests by leading pick, pack and ship fulfillment work accurately(if applicable) and assess reporting in fulfillment to identify gaps and assist to develop a plan.Responsible for collaborating with all teams and leaders (including closing team) to identify key priorities and ensure the store is guestready in alignment with your leader’s direction.Stay informed about relevant trends and products to educate team members by relaying Target communications from available tools and resources during team connection moments.Evaluate candidates for open positions and develop a guest-centric team, as directed by your immediate leader.Modela culture of executing all best practices as outlined with team onboarding and learning; help close skill gaps through development, coaching and team interactions.Work a schedule that aligns to guest and business needs (this includes early morning, evening, overnight shifts and weekends).Support guest services such as back-up cashier, digital fulfillment processes while maintaining a compliance culture, including compliance with federal, state, and local adult beverage laws.Demonstrate inclusivity by valuing diverse voices and approaches, being authentic and respectful, and creating equitable experiences.Demonstrate a culture of ethical conduct, safety and compliance; lead and hold the team accountable to work in the same way.Lead and demonstrate a safety culture through modeling and recognizing safe behaviors, identifying and correcting hazards, holding team accountable to following safety expectations, assisting with incident response, and reporting/investigating injuries timely and accurately.Model the execution of physical security processes in order to enhance the instore security culture.Support merchandise protection strategies across the total store; including ordering, storage and application as directed by best practices.Model creating a welcoming experience by greeting guests as you and your team are completing your daily tasks.Demonstrate how to engage with guests when assistance is needed, engage with guests in a welcoming way, and help solve their specific needs.Lead by thanking guests and let them know we’re happy they chose to shop at Target.If applicable, as a key carrier, follow all safe and secure training and processes.Address all store emergency and compliance needs.All other duties based on business needsWHAT WE ARE LOOKING FORThis may be the right job for you if:You enjoy interacting and helping others - including guests that shop our store and fellow team members you work with. You thrive in a fast-moving, highly active and physically demanding role, where teamwork, flexibility, and creative problem solving are key to success. You are open to working a flexible work schedule with varying hours, days or shifts (including nights, weekends, holidays and other peak shopping times).The good news is that we have some amazing training that will help teach you everything you need to know to be a General Merchandise Team Leader. But, there are a few things you need from the get-go:High school diploma or equivalentAge18 or olderPrevious retail experience preferred, but not requiredAbility to:Lead and hold others accountableCommunicate on multiple frequency devices and operate handheld scanners, and other technology equipment as directedWork independently and as part of a teamManage workload and prioritize tasks independentlyCapability to remain focused and composed in a fast-paced environment and accomplish multiple tasks within established timeframesWelcoming and helpful attitude toward all guests and other team membersEffective communication skills We are an awesome place to work and care about our teams, so we want to make sure we are clear on a few more basics that we expect: Access all areas of the building to respond to guest or team member issuesInterpret instructions, reports and informationAccurately handle cash register operations as neededClimb up and down laddersas neededScan, handle and move merchandise efficiently and safely, including frequently lifting or moving merchandise up to 44 pounds Flexible work schedule (e.g., nights, weekends and holidays); reliable and prompt and regular attendance necessaryCapable of working in and exposure to varying temperatures, humidity, and other elements while performing certain job duties including but not limited to Drive-Up, carryout, etc.Ability to remain mobile for the duration of a scheduled shift (shift length may vary).Target will consider for employment qualified applicants with criminal histories in a manner consistent with the San Francisco and City of Los Angeles Fair Chance Ordinances.Benefits EligibilityPlease paste this url into your preferred browser to learn about benefits eligibility for this role: https://tgt.biz/BenefitsForYou_C | Pegue esta URL en su navegador preferido para obtener información sobre la elegibilidad de este puesto para recibir beneficios: https://tgt.biz/BenefitsForYou_CAmericans with Disabilities Act (ADA)Target will provide reasonable accommodations with the application process upon your request as required to comply with applicable laws. If you have a disability and require assistance in this application process, please visit your nearest Target store or reach out to Guest Services at 1-800-440-0680 for additional information.

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

Description & Requirements Description Sign-On Bonus: $500 Compensation:$26 - $32 Per Hour - Full time, based upon experience Promotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare: Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience: Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA, Program Management,and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob Description Intercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking Behavioral Program Managerswho share our passion for improving the lives of children and families affected by autism. A Behavioral Health or (ABA)Program Manager serves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, and able to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor! Learn more about us on You Tube! This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health. Closing: If you have experience in any of the following fields, we encourage you to apply: Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBA Intercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance. Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Description The Site Supervisor works under the direction of the Director of Imaging in planning, directing and coordinating all aspects of the Imaging Department to include Radiology, Ultrasound, CT and MRI. Is responsible for all daily operations of the center to include: technical aspects of diagnostic procedures, liaison between the radiologist and the technical & office staff, supply management, staffing, performance reviews and disciplinary process of staff. Responsible for staff scheduling, quality control, statistics, film quality, customer service outcomes and compliance with Federal and State rules and regulations. Strong leadership skills with ability to communicate to staff and physicians required. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Little Company Of Mary Torrance Hospital and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: Associate's Degree in Radiological Technology or equivalent in approved A.M.A. program.California Diagnostic Radiologic Technology Certification upon hire. OrCalifornia Fluoroscopy Certificate/Permit upon hire. OrCalifornia Therapeutic Radiologic Technology Certification upon hire. OrCalifornia Diagnostic and Therapeutic Radiologic Technology Certification upon hire. OrNational Registered Diagnostic Medical Sonographer upon hire. OrNational Certification from American Registry of Radiologic Technologists upon hire. OrNational Certification from American Registry for Diagnostic Medical Sonography upon hire. OrNational Certified MRI Technologist - American Registry of Magnetic Resonance Imaging Technologists upon hire. OrNational Certification from Nuclear Medicine Technology Certification Board upon hire.National Provider BLS - American Heart Association upon hire.2 years of Progressively more responsible experience in acute care setting. Why Join Providence Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. About the Team The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 366994 Company: Providence Jobs Job Category: Diagnostic Imaging Job Function: Clinical Care Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 7014 LCMT MAMMO Address: CA Torrance 4101 Torrance Blvd Work Location: Providence Little Co of Mary Medical Ctr-Torrance Workplace Type: On-site Pay Range: $57.12 - $90.18 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

The pay range per hour is $24.75 - $42.05Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at .ALL ABOUT TARGETWorking at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. ALL ABOUT FOOD & BEVERAGE The Food & Beverage team enables a consistent experience for our guests by ensuring product is fresh, in stock, available and accurately priced and signed on the sales floor. They are experts of operations, process and efficiency. This team leads food and food services including replenishment, inventory accuracy, food safety, presentation, ensuring price accuracy and promotional signing processes for all Food & Beverage areas of the store.At Target, we believe in our leaders having meaningful experiences that help them build and develop skills for a career. The role of a Food & Beverage Team Leader can provide you with theskills and experience of: Guest service fundamentals and experience building a guest first culture on your team Food & Beverage business fundamentals: department sales trends, freshness and quality, inventory management, guest shopping patterns and pricing and promotions strategiesPlanning department(s) daily/weekly workload to support Food & Beverage priorities and deliver sales goalsLeading a team of hourly team members; including skills in interviewing, developing, coaching, evaluating and retaining talentAs a Food & Beverage Team Leader, no two days are ever the same, but a typical day will most likely include the following responsibilities:Understand sales goals, plan and execute daily/weekly workload to deliver on department and store sales goals and guest engagement, including: merchandising, pricing, changes to salesfloor merchandise displays, samplingand promotions.Assess backroom and sales floor areas of Food & Beverage and Food Service (where applicable) on a daily basisbywalkingthe Target Food &Beverage Standards.Prioritizeyour business needs and identify workload tasks for the team; review reporting to identify business trends for follow-up.At the guidance of your direct leader, establish clear goals and expectations and hold team members accountable to expectations.Maintaina fresh, full and food safe area during all operating hours leveraging strong inventory management,area routines and Food Safety policies and procedures.Deliver the Food & Beverage Standards.Validate and follow-up on team members’progress against their assigned prioritized workload tasks, production area routines, and application of best practices.Work a schedule that aligns to guest and business needs (this includes early morning, evening, overnight shifts and weekends).Assign daily tasks to TMs based on planned workload and guest traffic patterns, ensuring alignment with weekly and monthly business priorities set by your direct leader.Develop andmaintainpartnershipswith vendorsto ensure clear expectations are established, brand standards (such as delivery and merchandising) are being met and areas are full and maintained.Foster a productive relationship with your Starbucks district manager DM (if applicable), attend required in-store planning and business meetings and follow-up on key takeaways from their time in your store.Ensure product is available for guests by placing store-initiated orders with vendors according to best practices (where applicable).Remain up-to-date on relevant trends and products toeducate team members.Support your leader in the hiring and onboarding process of new team members. Participate in team hiring and onboarding processesBecome a subject matter expert in federal, state and local adult beverage laws as they apply to your business and protect thestore’s liquor license (if applicable).Lead your team to uphold and maintain all Starbucks and Pizza Hut Brand Standards and foster a productive partnershipwith your Starbucks district manager, following-up on key takeaways from their time in your store (if applicable).In addition to Food Safety Manager Certification, complete all Starbucks and/or Pizza Hut training requirements or certifications (if applicable).Fulfill key carrying responsibilities, as the business needs and follow all safe and secure training and processes.Support guest services such as back-up cashier, order pick up (OPU) and Drive-up (DU) and maintain a compliance culture while executing those duties, such as compliance with federal, state, and local laws.Demonstrate a culture of ethical conduct, safety and compliance; Lead team to work in the same way and hold others accountable to this commitment.Lead and demonstrate a safety culture through modeling and recognizing safe behaviors, identifying and correcting hazards, holding team accountable to following safety expectations, assisting with incident response, and reporting/investigating injuries timely and accurately.Model the execution of physical security processes in order to enhance the instore security culture.Support merchandise protection strategies across the total store; including ordering, storage and application as directed by best practices.Demonstrate inclusivity by valuing diverse voices and approaches, being authentic and respectful, and creating equitable experiences.Lead and demonstrate a culture of executing all best practices; help close skill gaps through development, coaching and team interactions.Address all store emergency and compliance needs.Support guest services such as back-up cashier, order pick up (OPU) and Drive-up (DU) and maintain a compliance culture while executing those duties, such as compliance with federal, state, and local lawsModel creating a welcoming experience by greeting guests as you & your team are completing your daily tasks. Demonstrate how to engage with guests when assistance is needed, engage with guests in a welcoming way, and help solve their specific needs.Lead by thanking guests and let them know we’re happy they chose to shop at Target.All other duties based on business needsWHAT WE ARE LOOKING FORThis may be the right job for you if:You enjoy interacting and helping others - including guests that shop our store and fellow team members you work with. You thrive in a fast-moving, highly active and physically demanding role, where teamwork, flexibility, and creative problem solving are key to success. You are open to working a flexible work schedule with varying hours, days or shifts (including nights, weekends, holidays and other peak shopping times).The good news is that we have some amazing training that will help teach you everything you need to know to be a Food & Beverage Team Leader. But, there are a few things you needfrom the get-go:High school diploma or equivalentAge 18 or olderPrevious retail and/or food experience preferred, but not requiredStrong interest and knowledge of the Food & Beverage businessAbility to:Lead and hold others accountableCommunicate on multiple frequency devices and operate handheld scanners, and other technology equipment as directedWork independently and as part of a teamManage workload and prioritize tasks independentlyCapability to remain focused and composed in a fast-paced environment and accomplish multiple tasks within established timeframesWelcoming and helpful attitude toward all guests and other team membersEffective communication skills We are an awesome place to work and care about our teams, so we want to make sure we are clear on a few more basics that we expect: Access all areas of the building to respond to guest or team member issuesInterpret instructions, reports and informationAccurately handle cash register operationsas neededClimb up and down laddersas neededScan, handle and move merchandise efficiently and safely, including frequently lifting or moving merchandise up to 44 pounds Flexible work schedule (e.g., nights, weekends and holidays); reliable and prompt and regular attendance necessaryAbility to work in an environment that could range from 34°F to -10°F as neededAbility to work in spaces where common allergens may be handled or presentCapable of working in and exposure to varying temperatures, humidity, and other elements while performing certain job duties including but not limited to Drive-Up, carryout, etc.Ability to remain mobile for the duration of a scheduled shift (shift length may vary).Target will consider for employment qualified applicants with criminal histories in a manner consistent with the San Francisco and City of Los Angeles Fair Chance Ordinances.Benefits EligibilityPlease paste this url into your preferred browser to learn about benefits eligibility for this role: https://tgt.biz/BenefitsForYou_C | Pegue esta URL en su navegador preferido para obtener información sobre la elegibilidad de este puesto para recibir beneficios: https://tgt.biz/BenefitsForYou_CAmericans with Disabilities Act (ADA)Target will provide reasonable accommodations with the application process upon your request as required to comply with applicable laws. If you have a disability and require assistance in this application process, please visit your nearest Target store or reach out to Guest Services at 1-800-440-0680 for additional information.

Your Role The Social Programs team is responsible for the support, oversight and administration of Social Programs benefits and services ensuring that our eligible members receive appropriate services in-line with benefits and services that is member-centered and in the communities where our members seek care. The Program Manager Clinical, Senior will report to the Senior Manager, Social Programs Management. In this role you will primarily provide administrative and operational organization, compliance oversight, updates, and contract adherence.Your Work In this role, you will: Direct small-scale, complex programs/projects that may involve multiple internal and external stakeholdersManage the development and implementation of process of the company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or productsBe responsible for assigning and monitoring the work of team members and providing guidance and leadershipDevelop the program, integrated program plan, resource plan, contingency plan, and related project management artifactsDefine and track program milestones while developing, maintaining, and reporting on an overall integrated delivery planProvide overall program leadership, guidance, and manage all aspects of a given program, including contract, budget, reporting, operations, and vendor/provider oversightDevelop strategies to ensure optimum support for projects and for the day-to-day operational activitiesLead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders Write and maintain processes and procedures to ensure compliancePerform other assigned duties, as requiredYour Knowledge and Experience Requires a bachelor’s degree or equivalent experienceRequires at least 5 years of prior relevant experienceRequires LCSW, LMFT, LPCC, PSYD or similar by the Board of Behavioral SciencesRequires experience collaborating with provider groups, community resources, and agenciesRequires program, project, and vendor/provider management experienceRequires strong administrative skills including proficiency in Excel, Microsoft Word and Microsoft Outlook and the ability to multitask and track multiple projects/deliverables at one timeRequires strong analytical, problem solving, and communication skillsRequires at least 2 years prior relevant experience working with a Managed Care Plan and Medi-Cal

Description & Requirements Description Sign-On Bonus: $500 Compensation:$26 - $32 Per Hour - Full time, based upon experience Promotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare: Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience: Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA, Program Management,and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob Description Intercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking Behavioral Program Managerswho share our passion for improving the lives of children and families affected by autism. A Behavioral Health or (ABA)Program Manager serves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, and able to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor! Learn more about us on You Tube! This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health. Closing: If you have experience in any of the following fields, we encourage you to apply: Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBA Intercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance. Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role The Care Management team 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 Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers perform a blended function of utilization management (UM) and 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: Research and design treatment /care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for eachappropriate plan type.Initiation of 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 ages.Determines appropriateness of referral for CM services, mental health, and social services.Provides Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD).Conducts member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental casesManages member treatment in order to meet recommended length of stay. Ensures DC planning at levels of care appropriate for the members needs and acuity.Assessment: Assesses members health behaviors, cultural influences and clients belief/value system. Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers.Research opportunities for improvement in assessment methodology and actively promotes continuous improvement. Anticipates potential barriers while establishingrealistic goals to ensure success for the member, providers and BSC.Determines realistic goals and objectives and provides appropriate alternatives. Actively solicits client’s involvement.Planning: Designs appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. Adjusts plans or creates contingency plans as necessary.Assesses and re-evaluates health and progress due to the dynamic nature of the plan of care required on an ongoing basis. Initiates and implements appropriate modifications in plan of care to adapt to changes occurring over time and through various settings.Develops appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes.Recognizes need for contingency plans throughout the healthcare process.Develops and implements the plan of care based on accurate assessment of themember and current of proposed treatment.Your Knowledge and Experience Bachelors of Science in Nursing or advanced degree preferred.Requires a current CA RN LicenseCertified 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 fieldA minimum of 3+ years managed care experience in inpatient, outpatient or managed care environment preferredHealth insurance/managed care experience preferredTransitions of care experience preferred • Excellent communications skills

Description & Requirements Description Sign-On Bonus: $500 Compensation:$26 - $32 Per Hour - Full time, based upon experience Promotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare: Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience: Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA, Program Management,and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob Description Intercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking Behavioral Program Managerswho share our passion for improving the lives of children and families affected by autism. A Behavioral Health or (ABA)Program Manager serves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, and able to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor! Learn more about us on You Tube! This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health. Closing: If you have experience in any of the following fields, we encourage you to apply: Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBA Intercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance. Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role The Behavioral Health (BH) Utilization Management (UM) Specialty team manages continuity of care, exceptions requests, and provides support for the clinical Utilization Management team. The Manager, Operations (BH UM Specialty) will report to the Sr. Manager, Operations (BH UM Intake). In this role you will oversee day to day operations, performance oversight and audit readiness.Your Work In this role, you will: Responsible for a singular team, department or functional area. Scope of oversight includes planning, cost management and methodsDemonstrate BSC Leadership BehaviorsFoster a great place to work by clearly communicating mission, vision, goals, roles, and expectations for team members; celebrating team achievements; building successful working relationships across the organizationDirect and control the activities of one or more smaller/less complex department(s) or functional area(s) through subordinate supervisors/team leadsEstablish operational objectives for department or functional area and participates with other managers to establish group objectivesDevelop and support non-clinical processes to assist the clinical BH UM teamOversee caseload management and adherence to regulatory accreditation and contractual requirementsDevelop production standards and monitor staff productivityProvide coaching, mentoring and guidance to non-clinical staffIdentify process improvement opportunities and independently drive solutionsYour Knowledge and Experience Requires a college degree or equivalent experience and minimum 7 years prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program managerUnderstands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegationUnderstands Blue Shield of CA’s mission and business planHas functional expertise within the area of responsibilityRequires advanced knowledge of job area usually obtained through advanced education combined with experienceRequires 3 years of experience working in a customer experience environment focused on providing provider, member or client support.Requires 3 years of experience working in a Call Center environment.Requires strong critical thinking skillsRequires the ability to work and make decisions independentlyRequires strong written and verbal communication skills

Description & Requirements Description Sign-On Bonus:$750Compensation: $26 - $32 Per Hour-Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningEducation, Experience, Certification Requirements:Master’s degree in education, psychology, counseling, behavior analysis, behavior science, human development, social work, rehabilitation, or related field, requiredStrong ABA, Program Management,and clinical skillsEnrollment in and/or completion of behavior-analytic coursework, preferred2+ years of experience implementing behavior treatment under the supervision of a BCBA, preferred2+ years of experience with students demonstrating significant behavioral challenges, preferred1+ year experience working in a school setting, preferredJob DescriptionThe Manager of School Services conducts FBAs and develops function based BIPs for assigned students identified to demonstrate significant behavioral challenges. The Manager designs, implements, and evaluates delivery and effectiveness of environmental modifications and instructional protocols as outlined in the BIP and other IEP goals. The Manager collaborates with and trains the student’s educational team on implementation of the BIP and specific protocols and provides direct supervision to and oversight of the assigned Behavior Technician team.Scheduling for this position matches the academic calendar of assigned schools. Intercare Therapy may schedule in-service or training days on non-instructional days. We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

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 Senior Medical Director FEP Prior Authorization and Post Review will report to the Vice President, Medical Management or their designee. In this role you will deliver and collaborate on clinical review activities, which includes management of the physician processes in support of utilization management and transactional functions for Federal Employee Program (FEP) membership. These functions include performance of pre-service and retrospective utilization review, Appeals and Grievances, and provider claims dispute reviews. The Senior Medical Director for FEP Prior Authorization and Post Review facilitates performance management and goals in alignment with organizational goals for the FEP membership. Moreover, this role leads or meaningfully contributes to the Blue Shield priorities and transformative initiatives that continue to improve the health and wellbeing of Blue Shield of California FEP members. You will also provide direction and leadership in compliance to regulatory requirements and key operational metrics and work collaboratively with the VP of Medical Management and Medical Directors in Utilization Management to achieve these goals.Your Work In this role, you will: Complete assigned clinical reviews (IP Admission and Concurrent, Lower Level of Care, Preservice requests, Post-service medical claim review, Provider Claims Disputes, Medical pharmacy, or others) within compliance standards while supporting clinical staff in maintaining high quality clinical reviews and work products and process improvement and optimization efforts for FEP membershipProvides clinical leadership and HR oversight for FEP Medical Director teamPartner closely with the VP Medical Management and Medical Directors in Utilization Management to develop improved utilization of effective and appropriate services, and support operational implementation of transformation initiatives for the FEP membershipSupport VP, Medical Management and Medical Directors in Utilization Management in coordinating the care of FEP membership to provide access to high-quality health care to these membersServe as a clinical, regulatory and quality improvement resource and clinical thought leader within the organizationSupport Vice President, Medical Management in strategic initiatives whether by proposing clinical initiatives, providing expert input, shaping the strategy, and/or serving as the initiative driverCollaborate with teams in the implementation and operation of assigned initiativesUnderstands and abides by all departmental policies and procedures as well as the organization’s Standards of Conduct and Corporate Compliance ProgramAttends mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct classParticipates in assigned CommitteesAbides by all applicable laws and regulations as mandated by state and federal lawAny other assigned dutiesYour Knowledge and Experience A Medical degree (M.D./D.O.) Completed residency preferably in adult based primary care specialty (e.g. internal medicine, family practice)Maintain active, unrestricted California State Medical License requiredMaintain Board Certification in one of ABMS categories required (preferably Internal Medicine)Minimum of 2 years of previous medical leadership experienceMinimum 5 years direct patient care experience post residency in: Internal Medicine (e.g. Neurology, Rheumatology), Family Practice (e.g. Psychiatry, Geriatrics, OBGYN), Adult based care, Internal Medicine (e.g. Neurology, Rheumatology), Family Practice (with 5+ years of inpatient experience), Psychiatry, Geriatrics, OBGYNDemonstrated proficiency in at least 3 of the following: MEDICARE/MEDICARE STARS, NCQA/URAC/Quality Programs, Policies/Procedure, Litigation, SIU/Waste/Fraud/Abuse, Appeals/Grievances, Case Management/Population HealthKnowledge and skilled application of national evidence-based medical necessity criteria references (MCG or InterQual)An ability to work independently to achieve objectives and resolve issues in ambiguous circumstancesClear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communicationsStrong collaboration skills to effectively work within a team that may consist of diverse individuals who bring a variety of different skills ranging from medical to project management and moreExcellent written and verbal communication skillsExcellent analytical, time management and organizational skillsProficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint

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

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

Your Role The Care management team is looking for a leader with Medi-Cal experience who can help design and lead our Medi-Cal line of business. The Senior Manager of Care Management, Medi-Cal will report to the Director of Care Management in the Population Health Department.. In this role you will be will serve as the professional leader of registered nurses within Blue Shield care management who is a good collaborator, experienced in people leadership, and will serve as a mentor and advisor to senior leadership. The selected candidate will also function as the subject matter expert on professional nursing/ care management for Medi-Cal regulations- who will represent care management in initiatives, client presentations, act as a liaison between other business units within Blue Shield to bolster care management knowledge on community resources, best practices, and promote holistic and integrated approach to medical care management..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,buildingand sustaining high-performing teams, getting results the right way, and fostering continuous learning.Your WorkYour WorkIn this role, you will:Establish operational objectives for department or functional area andparticipatesand leads other managers to establish group objectivesBe responsible for team, department or functional area results in terms of planning, cost and methods in collaboration with DirectorParticipate in the development and implementation of the annual budget under the direction of DirectorEnsure workflow procedures and guidelines are clearly documented and communicatedInterpret or initiate changes in guidelines/policies/proceduresProvides leadership to ensure best utilization of resources in obtaining organizational goals, regulatory compliance, adhering to corporate policies through oversight of daily operations, assessment of adequacy of staffing, and adherence to standard of social workersEnhancement or creation of care management processes in compliance with regulatory requirementsMaintenance and operationalizing of the Model of Care (MOC) for Medi-Cal SPD members, Cal-AIM, and other contracts with DHCS and CMS in close collaboration with and guidance from Director of Care ManagementResponsible for ensuring that the care management department readiness for internal and external regulatory and accreditation auditsPrimary involvement with committees, projects, initiatives, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the populationFocused on services and programs to increase quality of life and health of all membersMacro level collaboration and involvement with committees, projects, initiatives, community leaders, county social service personnel, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the populationDemonstrates a passion for leading positive change by enhancement and sustainment of an innovative care management program that advocates for patient safety by keeping informed of mandates, regulations, and best practice innovationsEnhancement and development of client health education, Advance Healthcare Planning and End of Life counseling and support and promotes participation in staff, patient, and community educationPromotion of best practice in impacting social determinants of health and homelessnessRepresent Blue Shield care management in Blue Shield sponsored community events and fairsRegular collaboration with other Blue Shield managers in care management and other business unitsMaintain daily measurement standards and outcomes for staffAn active participant in practice transformationYour Knowledge and ExperienceRequires a bachelor's degree or equivalent experienceRequires a current CA RN LicenseCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 10 years of prior relevant experience including 4 years of management experience gained as a team leader, supervisor, or project/program managerRequires health insurance/managed care experience (Commercial, Medicare, and Medi-Cal).Requires excellent communication, presentation, and procedure-writing skillsLean methodology desiredAdvanced degree preferred

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