ABOUT USTogether, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community. From our family to the nation’s schools, we remain focused on providing a world of opportunities for you to leverage your abilities and make an impact on special education. Apply today!POSITION DESCRIPTIONEpic Special Education Staffing is partnering with an exceptional school district who is looking for a contract School Certified Occupational Therapist Assistant (COTA) for the 2025 - 2026 school year.·Duration: 8/11/2025 - 06/04/2026·Location: Marysville, CA·Location Type: On-Site·Schedule: Full Time·Hours: 30.00·Grade/Age Levels: Elementary School;High School;Kindergarten;Middle School·Weekly Pay Range: $36.00 - $41.40 per hour on a local contractBENEFITSWe offer a variety of benefits for you and your loved ones. As a valued and respected part of the Epic family, you will enjoy:·Competitive compensation packages for both local and travel contracts·Medical, Dental, and Vision benefits·Infertility & Domestic Partner Coverage·Summer Insurance Coverage·PTO & Holiday Pay·401K matching·Wellness and Employee Assistance Program (EAP)·CEU & license reimbursements·Referral bonuses of $1000QUALIFICATIONSThe minimum qualifications for School Certified Occupational Therapist Assistant (COTA):·1 year of verifiable, professional experience as School Certified Occupational Therapist Assistant (COTA) within the last 3 years (may include residency or clinical practicum)·Valid School Certified Occupational Therapist Assistant (COTA) credential/license or in process in state of practice·Employees must be legally authorized to work in the United States and will be asked for proof upon hire. We are unable to sponsor or take over sponsorship of an employment Visa at this time.·We will consider all qualified applicants for employment, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws.·Epic Staffing Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, housing, age, disability or genetics.At Epic Special Education Staffing, you will have the opportunity to apply your unique experience and expertise with school-based special education as your singular focus. We offer stimulating and rewarding careers that provide an opportunity to make a difference in a child's life! Earn more for referring your friends! For a limited time, we are increasing our Referral Bonus for select positions! You could receive up to $2,250 bonus and a $250 charitable contribution! Submit your referrals by October 31, 2025, and ensure your friend begins their contract during the 2025-2026 school year to qualify.By applying for this position, you agree that any calls from Epic Staffing Group and its subsidiaries may be monitored or recorded for training and quality assurance purposes.

Overview: Licensed Certified Occupational Therapy Assistant (COTA) - Care Coordination ProgramOccupational Therapy + Care Coordination: The Best of Both Worlds!We’re looking for Certified Occupational Therapy Assistants to support our innovative new care coordination program! This opportunity empowers you to practice at the top of your license, while giving you the chance to branch out into care coordination duties designed to standardize your hours and grow your career. All this plus truly flexible scheduling, amazing benefits, and the ability to make a huge difference in the lives of seniors! Responsibilities: The OpportunityWe are hiring a licensed Clinical Occupational Therapy Assistant (COTA) to join our team and work with the residents of a senior living community that offers one or more of the following care settings: independent living, assisted living, and memory care. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part B. As a COTA, you will be responsible for: Providing occupational therapy and wellness services for older adults under the supervision of a OT as part of a multidisciplinary teamSupport care coordination efforts by conducting regular wellness checkpoint visits with patients, communicating with patients’ providers and caregivers, and assisting patients with attending telehealth visitsMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesContributing to program development, quality improvement, and problem-solvingAssist with optimizing each patient’s functional well-being and satisfactionYour ScheduleWhile our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle!Our Amazing BenefitsAll Employees Get: Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind! 401(k) Eligibility with Opportunity for Matching FundsAmazing Career Advancement and Cross Training OpportunitiesRecognition ProgramsEmployee Assistance ProgramPart-Time Employees Also Get:Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Full-Time Employees Also Get:Full Benefits, including HSA, FSA, and Life & Disability InsuranceVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffYou’re Our Perfect Fit If...You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a jobyou seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights.Plus, you have the following: Completion of an accredited Occupational Therapy Assistant program (New Grads Welcome) Current COTA state licensure Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! Professional curiosity and a knack for finding solutionsCome be a part of our mission to make a positive impact on the lives of seniors. Apply today Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $33.00 - $47.00 per hour

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

Physical Therapist Assistant - RehabWe are seeking a dedicated Physical Therapist Assistant to join our rehabilitation team. In this role, you will support physical therapists in providing treatments that help patients improve mobility, relieve pain, and regain independence.Key Responsibilities:Assist physical therapists in implementing treatment plans tailored to patients' needs.Instruct patients in exercises designed to improve strength, balance, or coordination under supervision.Monitor patients during therapy sessions and report progress or challenges to the supervising therapist.Maintain accurate documentation of treatments provided and patient responses.Ensure therapy equipment is clean, organized, and ready for use during sessions.Work Environment:Work in rehabilitation centers, hospitals, or outpatient clinics under the supervision of licensed physical therapists.A collaborative environment focused on achieving optimal patient outcomes through teamwork.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through training and certifications.A supportive workplace culture that values collaboration and innovation in patient care delivery.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Travel Postpartum RNCompany: Fusion Medical StaffingLocation: Facility in Folsom, CAJob DetailsFusion Medical Staffing is seeking a skilled Postpartum RN for a 13 week travel assignment in Folsom, CA. As a member of our team, you'll have the opportunity to make a positive impact on the lives of patients while enjoying competitive pay, comprehensive benefits, and the support of a dedicated clinical team.Required Qualifications:One year’s recent experience as a postpartum RN Valid RN license in compliance with state regulationsCurrent BLS (AHA/ARC) CertificationNRP CertificationPreferred Qualifications:ACLS CertificationOther certifications and licenses may be required for this positionSummary:The Postpartum Registered Nurse provides specialized, family-centered care to mothers and newborns in the postpartum unit. This role involves assessing maternal and newborn health, implementing care plans, supports breastfeeding and educating families on postpartum and newborn care. The Postpartum RN collaborates with healthcare teams to ensure optimal outcomes and demonstrates advanced clinical skills, critical thinking, and a commitment to patient safety and professional ethics.Essential Work Functions:Explains postpartum and newborn care procedures to mothers and families to gain cooperation, understanding, and alleviate apprehensionAdministers prescribed medications and treatments to mothers and newborns safely and accurately, following established protocolsAssess and monitor the health of postpartum mothers and newborns, identifying changes, addressing complications, and recording significant conditions and reactionsAssists with and educates on breastfeeding, addressing challenges to ensure successful feeding practicesPerforms newborn assessments, including vital signs, weight checks, and required screening testsResponds to life-saving situations using evidence-based protocols and best practicesCollaborate with interdisciplinary teamsEducates new parents on infant care, maternal recovery, and postpartum health, including safe sleep practices and early signs of complicationsPrepares equipment and aids physicians during examinations and any necessary postpartum or neonatal proceduresMaintains awareness of comfort and safety needs of mothers and newborns, ensuring a safe, supportive environment for bondingDocuments all relevant history and physical assessments for assigned patients accurately in medical recordsPerforms other duties as assignment within the scope of the practiceRequired Essential Skills:Critical thinking, service excellence and good interpersonal communication skillsThe ability to read, write, & communicate in the English language is requiredAbility to read/comprehend written instructions, follow verbal instructions, and proficiency in PC skillsPhysical Abilities - Remain in a stationary position, move about, move equipment (50-100lbs), pushing, pulling, bendingInterpersonal Skills - To work effectively with a variety of personnel (professional and ancillary) to present a positive attitude and professionalismTechnical/Motor Skills - Ability to grasp, fine manipulation, pushing/pulling and able to move about when assisting with procedures and/or using department equipment.Mental Requirements - Must be able to cope with frequent contact with the general public, customers, and meeting deadlines under pressure. Must be able to work under close supervision occasionally as well as working without assistance from other personnel. Must be able to contend with irregular activity schedules occasionally and continuous concentration to detailSensory - Visual acuity, ability to effectively communicate.Benefits Include:Highly competitive pay for travel professionalsComprehensive medical, dental, and vision insurance with first day coveragePaid Time Off (PTO) after 1560 hoursLife and Short-term disability offered401(k) matchingAggressive Refer-a-friend Bonus Program24/7 recruiter supportReimbursement for licensure and CEUsWhy Choose Fusion At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch, and we're always looking for people like you to join our mission. Your passion for helping others deserves a partner just as committed to supporting you that’s why we offer day one insurance, $0 copay for mental health services, scholarships and awards, exclusive discounts, and more. From your personal recruiter to our clinical and traveler experience teams, we’re here to guide and celebrate you along your journey. You take care of others; we take care of you.Other Duties Disclaimer:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned. This job description is not a comprehensive list of all activities, duties or responsibilities that are required of the employee for this job and is subject to change at any time with or without notice.Start your rewarding career as a Travel Postpartum RN with Fusion Medical Staffing and join our mission to improve lives. Apply now! *Fusion is an EOE/E-Verify Employer #pb13

Overview: Sonrava Health is in search of a passionate full time General Dentist who loves to ONLY treat children for our offices in Sacramento, CA. If you are a dedicated Dentist looking for an exciting opportunity to make a difference in children's oral health, we have the perfect position for you!At Sonrava Health, we are committed to being a Dental Home for our patients, offering a lifetime of comprehensive services. Our Pediatric Dentists, like you, play a crucial role in realizing this vision by providing top-notch treatment in our fully-equipped dental facilities, complemented by our well-trained support staff.We pride ourselves on offering a range of Corporate Support Departments, including Billing, Quality Management, Procurement/Facilities, Human Resources, and IT. These departments are dedicated to providing you and the offices you work at with top-tier administrative and technological support. In the field, our clinical and operational management teams are focused on ensuring your days are efficiently scheduled so you can maximize your production.What We Offer:A consistently fully booked patient schedule.Responsibilities:As a Pediatric Dentist at Sonrava Health, you will:Collaborate closely with other specialists and general dentists to deliver optimal dental care for children.Be adaptable and available to travel to various dental practices in your local area.Perform a range of pediatric dental procedures, including but not limited to:ProphylaxisStainless Steel CrownsPulpotomyFillingsSealantsImmigration Sponsoring Programs:For eligible candidates, we offer Immigration Sponsoring Programs, including OPT, H-1B, TN, and Green Card sponsorship in select regions.Benefits:We value our Pediatric Dentists and provide a competitive benefits package, including:Guaranteed Daily Base Rates plus lucrative incentive programs.Part-time positions available, including 1099 options.Company Paid Professional Liability Insurance.Company Paid Continuing Education courses.401(k) retirement savings plan.Healthcare benefits for full-time providers.Join Sonrava Health and contribute to our mission of providing exceptional dental care to children. If you are a dedicated Pediatric Dentist seeking an exciting career opportunity in Bakersfield and Fresno, CA, apply today to be part of our team. Qualifications: We'll need you to provide:• Must have a current dental license for the state in which you wish to practice - New Grads Welcome!• Nitrous Sedation Certificate per State requirement• Current CPR Card• NPI Number• DEA Certificate

ABOUT USTogether, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community. From our family to the nation’s schools, we remain focused on providing a world of opportunities for you to leverage your abilities and make an impact on special education. Apply today!POSITION DESCRIPTIONEpic Special Education Staffing is partnering with an exceptional school district who is looking for a contract School Certified Occupational Therapist for the 2025 - 2026 school year.·Duration: 8/12/2025 - 06/05/2026·Location: Marysville, CA·Location Type: On-Site·Schedule: Full Time·Hours: 37.50·Grade/Age Levels: Elementary School;High School;Kindergarten;Middle School;Pre-K·Weekly Pay Range: $51.75 – $59.51 per hour on a local contractBENEFITSWe offer a variety of benefits for you and your loved ones. As a valued and respected part of the Epic family, you will enjoy:·Competitive compensation packages for both local and travel contracts·Medical, Dental, and Vision benefits·Infertility & Domestic Partner Coverage·Summer Insurance Coverage·PTO & Holiday Pay·401K matching·Wellness and Employee Assistance Program (EAP)·CEU & license reimbursements·Referral bonuses of $1000QUALIFICATIONSThe minimum qualifications for School Certified Occupational Therapist:·1 year of verifiable, professional experience as School Certified Occupational Therapist within the last 3 years (may include residency or clinical practicum)·Valid School Certified Occupational Therapist credential/license or in process in state of practice·Employees must be legally authorized to work in the United States and will be asked for proof upon hire. We are unable to sponsor or take over sponsorship of an employment Visa at this time.·We will consider all qualified applicants for employment, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws.·Epic Staffing Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, housing, age, disability or genetics.At Epic Special Education Staffing, you will have the opportunity to apply your unique experience and expertise with school-based special education as your singular focus. We offer stimulating and rewarding careers that provide an opportunity to make a difference in a child's life! Earn more for referring your friends! For a limited time, we are increasing our Referral Bonus for select positions! You could receive up to $2,250 bonus and a $250 charitable contribution! Submit your referrals by October 31, 2025, and ensure your friend begins their contract during the 2025-2026 school year to qualify.By applying for this position, you agree that any calls from Epic Staffing Group and its subsidiaries may be monitored or recorded for training and quality assurance purposes.

Your Role The Medical Care Solutions Post Service Clinical Review team is hiring one RN Manager who will be responsible for leading the clinical team that reviews post service and provider appeal cases for Commercial Behavioral Health reviews.. The RN Manager will report to the Senior RN Manager. In this role you will be responsible for inventory management, staffing, transformation readiness, audit readiness, reporting, special projects, compliance, training and documentation updates as well s be a resource for problem solving issues. 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 Work In this role, you will: Establish operational objectives for department and/or functional areas and participate with managers and stakeholders to establish shared objectivesBe responsible for team, functional area quality and compliance results. Prepare files for regulatory and internal audits. Participate in regulatory and internal audits when necessaryAdhere to the team’s annual budget and participate in budget planning under the direction of the team’s Manager and DirectorEnsureall work-flowprocedures and guidelines are clearly documented, updated, and communicatedtimely to the teamInterpret or initiate changes in guidelines/policies/proceduresDevelop and implement recommendations for improvement of quality and productionStay current on regulatory changes and industry requirementsResponsible for reporting and analysis, Post Service workflows, protocols, policies to ensure efficient and effective care coordinationCollaborate with internal business partnersYour Knowledge and Experience Bachelor of Science in Nursing or advanced degree preferred.Requires a current CA RN licenseRequires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program managerHas functional expertise within the area of responsibilityBehavioral Health experience preferredExperience with data analysis, trending, and inventory management preferredRegulatory audit experience with file preps, presentation, and CAP resolution preferredUnderstands basic management approaches such as work scheduling, prioritizing, coaching, and process execution, work organization, risk management, and delegation

Physical Therapist - Skilled Nursing Facility (SNF)If you are passionate about helping patients regain mobility and independence, consider joining our team as a Physical Therapist in a skilled nursing facility. You will design and implement rehabilitation programs tailored to residents' unique needs.Key Responsibilities:Assess residents' physical conditions and develop individualized treatment plans.Utilize therapeutic exercises, manual therapy techniques, and equipment to aid recovery.Educate residents on maintaining physical health and preventing future injuries.Collaborate with other healthcare professionals to ensure comprehensive care plans are executed effectively.Monitor progress and adjust therapy programs as needed for optimal outcomes.Work Environment:Provide care in skilled nursing facilities focused on long-term patient recovery.Work within a multidisciplinary team dedicated to enhancing residents' quality of life.Benefits:A competitive compensation package with benefits included.A focus on professional development through training programs and certifications.A supportive workplace culture that emphasizes teamwork and innovation.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Travel Physical Therapy Assistant (PTA)Company: Fusion Medical StaffingLocation: Facility in Yuba City, CAJob DetailsFusion Medical Staffing is seeking a skilled Physical Therapy Assistant (PTA) for a 13 week travel assignment in Yuba City, CA. As a member of our team, you'll have the opportunity to make a positive impact on the lives of patients while enjoying competitive pay, comprehensive benefits, and the support of a dedicated clinical team.Required Qualifications:Valid Physical Therapy Assistant license in compliance with state regulationsCurrent BLS certification (AHA/ARC)Preferred Qualifications:Graduate of an accredited program in physical therapyPhysical Therapy Assistant experience, but New Grads are welcome to applyOther certifications or licenses may be required for this positionSummary:The Physical Therapy Assistant (PTA) works under the supervision of a Physical Therapist to help implement treatment plans that improve patients' mobility, reduce pain, and enhance functional independence. PTAs provide hands-on assistance with therapeutic exercises, modalities, and activities of daily living across various clinical settings. They document patient progress, educate patients on home exercise programs, and collaborate with the healthcare team to support optimal recovery and overall quality of life.Essential Work Functions:Set up therapy equipment and treatment areas, ensuring all devices and supplies are calibrated, clean, and ready for patient sessionsGuide patients through prescribed exercises and activities to improve mobility, strength, and balance, while providing hands-on assistance with movements and transfers as neededObserve patient performance during therapy sessions, note changes in functional abilities, and report progress or concerns to the supervising Physical TherapistAccurately record patient treatment details, progress, and any adjustments made during therapy sessions in the medical recordInstruct patients and their caregivers on home exercise programs, proper use of assistive devices, and techniques for safe mobility and injury preventionWork in conjunction with physical therapists, occupational therapists, and other healthcare professionals to coordinate a comprehensive approach to patient careMaintain a safe treatment environment by adhering to infection control protocols, safety guidelines, and regulatory standards while addressing patients’ comfort needs during therapy sessionsEngage in quality assurance initiatives and professional development activities to remain current with best practices in physical therapyCollaborate in discharge planning to ensure smooth transitions and continued patient progress in community or home-based settingsPerforms other duties as assigned within scope of practiceRequired Essential Skills:Critical thinking, service excellence and good interpersonal communication skillsThe ability to read, write, & communicate in the English language is requiredAbility to read/comprehend written instructions, follow verbal instructions, and proficiency in PC skillsPhysical Abilities - Remain in a stationary position, move about, move equipment (50-100lbs), pushing, pulling, bendingInterpersonal Skills - To work effectively with a variety of personnel (professional and ancillary) to present a positive attitude and professionalismTechnical/Motor Skills - Ability to grasp, fine manipulation, pushing/pulling and able to move about when assisting with procedures and/or using department equipment.Mental Requirements - Must be able to cope with frequent contact with the general public, customers, and meeting deadlines under pressure. Must be able to work under close supervision occasionally as well as working without assistance from other personnel. Must be able to contend with irregular activity schedules occasionally and continuous concentration to detailSensory - Visual acuity, ability to effectively communicate.Benefits Include:Highly competitive pay for travel professionalsComprehensive medical, dental, and vision insurance with first day coveragePaid Time Off (PTO) after 1560 hoursLife and Short-term disability offered401(k) matchingAggressive Refer-a-friend Bonus Program24/7 recruiter supportReimbursement for licensure and CEUsWhy Choose Fusion At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch, and we're always looking for people like you to join our mission. Your passion for helping others deserves a partner just as committed to supporting you that’s why we offer day one insurance, $0 copay for mental health services, scholarships and awards, exclusive discounts, and more. From your personal recruiter to our clinical and traveler experience teams, we’re here to guide and celebrate you along your journey. You take care of others; we take care of you.Other Duties Disclaimer:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned. This job description is not a comprehensive list of all activities, duties or responsibilities that are required of the employee for this job and is subject to change at any time with or without notice.Start your rewarding career as a Travel Physical Therapy Assistant (PTA) with Fusion Medical Staffing and join our mission to improve lives. Apply now!*Fusion is an EOE/E-Verify Employer #pb6

Your Role The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Sr. Medical Director, Medical Policy will report to the Chief Medical Officer. In this role you will be accountable for ensuring that all medical, medication, and payment policy initiatives are in aligned with the scientific evidence and professional guidelines. You will lead a team that delivers medical policy that adapts to new clinical innovations and supports medical payment operations, and training for staff in the accurate application of medical, medication, and payment policy, pricing, and coding. In addition to chairing the BSC Pharmacy & Therapeutics, Medical and Payment Policy Committees, you will provide clinical leadership for all evidence-based medicine functions and partner closely with leaders of other business functions to develop strategies to ensure that Blue Shield members are receiving appropriate quality care.Your WorkIn this role, you will:Provide clinical thought leadership for the design and implementation of clinical policy innovation initiatives such as Coverage with Evidence Development, and the development of robust and efficient approaches to developing policies for emerging classes of technology like molecular diagnostics and mobile/digital personal health devicesChair the Medical Policy and Pharmacy and Therapeutics CommitteesProvide clinical leadership and medical consultation for the Blue Shield of California (BSC) medication management process, including working closely with the Pharmacy Services team to promote safe, effective, and cost-efficientProvide medical expertise in daily clinical rounds for drug authorization case reviewChair the Payment Policy Committee and provide clinical leadership for the BSC Payment Policy committee, overseeing and advising about payment policies and tactical approaches to ensure accurate coding of servicesConsult with BSC legal team to support fraud and abuse investigations, provider arbitrations, regulatory inquiries and issues, and litigation related to clinical policy, coding, or pricing issuesAct as BSC’s representative to the Blue Cross Blue Shield Association (BCBSA) Technology Assessment process and the Medical Policy PanelParticipate on the California Technology Assessment Forum and other related activitiesPartner with Network Management and Provider Partnership teams by providing subject matter expertise for contract and benefits coding decisions, including mandated benefits, provider contract language, provider DOFRs (division of financial responsibilities), and providing clinical perspective to resolve issues with BSC providers related to clinical policy, coding, and billing.Provide subject matter expertise for pricing of new, zero-dollar, and other exceptional claimsPresent at IPA/MG and Provider education seminars regarding medical, medication and payment policy Your Knowledge and ExperienceMinimum of 2 years of previous medical leadership experienceMinimum of 5 years of direct patient care experience post residencyMinimum of 8 years of experience developing evidence-based guidelines, medical policies or performing systematic reviews of the medical literatureMedical degree (M.D./D.O.) required. Master’s degree in epidemiology, health services or related degree is preferredCompleted residency preferably in adult based primary care specialty (e.g. Internal Medicine, Family Practice)Maintain active, unrestricted California State Medical License required; Maintain active, unrestricted Medical License in all additional assigned states requiredMaintain Board Certification in one of ABMS, ABOS, or AOA recognized specialty required (preferably Internal Medicine or Family Practice)Has mastery level knowledge and skills within a specific technical or professional discipline with broad understanding of other areas within the job functionOutstanding verbal and written communication skillsAbility to lead through influence in a matrixed organizationExperience performing utilization management reviews is preferredExperience in a health plan or managed care organization is preferred#LI-JS3

Radiology Technologist - CT Scan TechWe are seeking a skilled Radiology Technologist specializing in CT Scans to join our team. In this role, you will operate advanced computed tomography (CT) equipment to produce detailed diagnostic images, ensuring high-quality care and accurate results for patients.Key Responsibilities:Prepare patients for CT scan procedures by explaining the process, answering questions, and positioning them correctly.Operate CT scan equipment to capture high-quality diagnostic images while ensuring patient safety and comfort.Administer contrast materials when necessary to enhance imaging results, following established safety protocols.Collaborate with physicians to analyze imaging results and provide accurate diagnostic support.Maintain and calibrate CT equipment to ensure optimal performance and compliance with safety standards.Document procedures and maintain accurate patient records in compliance with regulatory requirements.Work Environment:Work in hospitals, diagnostic imaging centers, or outpatient facilities equipped with advanced CT technology.Engage in a fast-paced environment requiring attention to detail and technical expertise.Collaborate with a multidisciplinary team dedicated to delivering exceptional patient care.Benefits:Competitive salary and comprehensive benefits package.Access to cutting-edge technology and ongoing training opportunities.A supportive work environment focused on professional growth and innovation.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The MCS Clinical Service Intaketeam responsible for timely and accurate processing of Treatment Authorization Requests. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor of Clinical Services Intake. In this role you will be for supporting clinical staff day to day operations for Promise (Medi-Cal) or Commercial/Medicare lines of business.Your Work In this role, you will: Work in a production-based environment with defined production and quality metrics.Process Faxed /Web Portal /Phoned in Prior Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.Select support for Case Manager such as mailings and surveys.Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.Provide support to Advanced/Specialist CSC.Assign initial Extension Of Authority (EOA) days, or triage to nurses, based on established workflow.Research member eligibility/benefits and provider networks.Serves as the initial point of contact for providers and members in the medical management process by telephone or correspondence.Assists with system letters, requests for information and data entry.Provides administrative/clerical support to medical management.Intake (received via fax, phone, or portal). Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.Provide workflow guidance to offshore representatives. Other duties as assigned. Your Knowledge and Experience Requires a high school diploma or equivalentRequires at least 3 years of prior relevant experienceMay require vocational or technical education in addition to prior work experience1-year of work experience within the Medical Care Solutions’ Utilization Management Department or a similar medical management department at a different payor, facility, or provider/group preferred.In-depth working knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the Outpatient, Inpatient, DME and/or Home Health, Long Term Care and CBAS areas preferred.In-depth working knowledge of the systems/tools utilized for UM authorization functions such as AuthAccel, Facets, PA Matrix or other systems at a different payor, facility, or provider/group preferred.Ability to provide both written and verbal detailed prior authorization workflow instructions to offshore staff.Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.Knowledge of UM regulatory Turn Around Time (TAT) standardsKnowledge of clinical workflow to assist nurses with case creation, research/issue resolution and other UM related functions, as necessary.

Radiology Technologist - CT Scan TechWe are seeking a skilled Radiology Technologist specializing in CT Scans to join our team. In this role, you will operate advanced computed tomography (CT) equipment to produce detailed diagnostic images, ensuring high-quality care and accurate results for patients.Key Responsibilities:Prepare patients for CT scan procedures by explaining the process, answering questions, and positioning them correctly.Operate CT scan equipment to capture high-quality diagnostic images while ensuring patient safety and comfort.Administer contrast materials when necessary to enhance imaging results, following established safety protocols.Collaborate with physicians to analyze imaging results and provide accurate diagnostic support.Maintain and calibrate CT equipment to ensure optimal performance and compliance with safety standards.Document procedures and maintain accurate patient records in compliance with regulatory requirements.Work Environment:Work in hospitals, diagnostic imaging centers, or outpatient facilities equipped with advanced CT technology.Engage in a fast-paced environment requiring attention to detail and technical expertise.Collaborate with a multidisciplinary team dedicated to delivering exceptional patient care.Benefits:Competitive salary and comprehensive benefits package.Access to cutting-edge technology and ongoing training opportunities.A supportive work environment focused on professional growth and innovation.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Occupational Therapist - Acute Care We are seeking a dedicated Occupational Therapist to join our acute care team. In this role, you will evaluate and treat patients recovering from injuries, surgeries, or acute medical conditions to help them regain independence and improve their quality of life. Key Responsibilities: Assess patients' physical, cognitive, and emotional abilities to develop individualized treatment plans.Implement therapeutic interventions to enhance daily living skills and promote functional independence.Collaborate with interdisciplinary teams to ensure comprehensive patient care.Educate patients and families on strategies to maintain progress after discharge.Document patient progress and adjust treatment plans as necessary. Work Environment: The role is based in hospitals or acute care facilities where occupational therapists work with patients requiring immediate rehabilitation support.This position involves standing for long periods and assisting patients with mobility or task modifications. Benefits: A competitive salary with opportunities for advancement within acute care occupational therapy settings.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Access to continuing education programs to enhance expertise in acute care rehabilitation techniques. Equal Opportunity Employer: Your commitment to improving patient outcomes is valued here. We strive to create an inclusive environment where all employees can thrive professionally while delivering exceptional care to our patients during their recovery journeys. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant willwork as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring that evidence based clinical decisions are implemented appropriately to provide a high-quality and cost-effective pharmacy benefit. The Pharmacist, Consultant (Drug Utilization Review Pharmacist) will report to the Drug Utilization Review (DUR) Pharmacist Manager.Your Work In this role, you will: Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of businessApply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medicationsOperate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframesServe as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug useEmbrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goalUse clear and concise communications and on-brand messaging when communicating with providers or membersFollow all corporate policies and proceduresOperate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medicationsAssist in preparing materials for audits and reports; complete projects as assignedYour Knowledge and Experience Requires a Doctor of Pharmacy (PharmD) degreeRequires a currently active and unrestricted California Registered Pharmacist (RPh) licenseRequires at least 2 years of experience in clinical pharmacyExcellent oral and written communication skillsThorough knowledge of therapeutic use of medications

Radiology Technologist - MRI TechJoin our team as a Radiology Technologist specializing in MRI. You will operate advanced imaging equipment to create detailed diagnostic images, ensuring accurate results for patient care.Key Responsibilities:Prepare patients for MRI procedures by explaining the process and positioning them correctly.Administer contrast dyes when necessary to enhance imaging results.Operate MRI equipment to capture high-quality diagnostic images.Collaborate with physicians to analyze imaging results and provide accurate diagnoses.Maintain patient safety by adhering to established protocols and standards.Work Environment:Work in hospitals, diagnostic imaging centers, or outpatient facilities.Engage in a fast-paced environment requiring attention to detail and technical expertise.Benefits:Competitive salary and benefits package.Access to state-of-the-art technology and ongoing training opportunities.A collaborative work environment focused on patient care excellence.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant willwork as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring that evidence based clinical decisions are implemented appropriately to provide a high-quality and cost-effective pharmacy benefit. The Pharmacist, Consultant (Drug Utilization Review Pharmacist) will report to the Drug Utilization Review (DUR) Pharmacist Manager. *This is a short term position expected to last 1 year from hire*Your WorkIn this role, you will:Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of businessApply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medicationsOperate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframesServe as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug useEmbrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goalUse clear and concise communications and on-brand messaging when communicating with providers or membersFollow all corporate policies and proceduresOperate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medicationsAssist in preparing materials for audits and reports; complete projects as assignedYour Knowledge and ExperienceRequires a Doctor of Pharmacy (PharmD) degreeRequires a currently active and unrestricted California Registered Pharmacist (RPh) licenseRequires at least 2 years of experience in clinical pharmacyExcellent oral and written communication skillsThorough knowledge of therapeutic use of medications

Occupational Therapist - RehabWe are seeking a compassionate and skilled Occupational Therapist to join our rehabilitation team. In this role, you will help individuals regain independence by developing and implementing customized programs to improve daily living and vocational skills.Key Responsibilities:Assess patients' needs and develop individualized treatment plans.Use therapeutic techniques to improve patients' abilities to perform daily tasks.Adapt environments and modify tasks to remove barriers for patients.Teach patients and caregivers strategies for improving functionality and independence.Document patient progress and adjust treatment plans as necessary.Work Environment:Work in rehabilitation centers, hospitals, or outpatient clinics.Collaborate with a multidisciplinary team focused on patient recovery.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional development and continuing education.A supportive work environment that values innovation and teamwork.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Speech-Language Pathologist - OutpatientWe are seeking a compassionate Speech-Language Pathologist to join our outpatient team. In this role, you will assess and treat individuals with speech, language, voice, or swallowing disorders in an outpatient setting, helping them improve communication and quality of life.Key Responsibilities:Evaluate patients to determine the nature and extent of speech or language difficulties.Develop and implement individualized treatment plans aimed at improving communication and swallowing abilities.Provide therapy sessions focused on articulation, fluency, voice quality, or cognitive-communication skills.Collaborate with other healthcare professionals to ensure comprehensive care for patients.Educate patients and families on strategies to support communication improvement at home or work settings.Document patient progress and adjust therapy plans as needed for effective outcomes.Work Environment:Work in outpatient clinics focused on short-term rehabilitation or long-term therapy goals.Engage in a collaborative environment with other healthcare professionals dedicated to patient success.Benefits:A competitive salary with comprehensive benefits options available.A focus on professional growth through training opportunities and certifications support programs.A supportive workplace culture that values collaboration and innovation in patient care delivery systems.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Radiology Technologist - Interventional RadiologyWe are seeking a highly skilled Radiology Technologist specializing in Interventional Radiology to join our team. In this role, you will assist in minimally invasive procedures by using advanced imaging technology to guide interventions, ensuring accurate and effective patient care.Key Responsibilities:Prepare patients for interventional radiology procedures by explaining the process and positioning them appropriately.Operate fluoroscopy and other imaging equipment to provide real-time guidance during procedures.Assist physicians in performing diagnostic and therapeutic interventions, such as angiograms, stent placements, or biopsies.Maintain a sterile environment and adhere to infection control protocols during procedures.Monitor patients' vital signs and ensure their safety and comfort throughout the procedure.Document procedures accurately and maintain detailed patient records.Perform routine maintenance and quality checks on imaging equipment to ensure optimal performance.Work Environment:Work in hospitals or specialized interventional radiology suites equipped with advanced imaging technology.Collaborate closely with physicians, nurses, and other healthcare professionals in a fast-paced environment.Be prepared for on-call responsibilities to assist with urgent or emergency procedures.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through specialized training and certifications.A supportive work environment that values innovation and teamwork 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 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 Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. 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: Review concurrent, pre- and post-service behavioral health service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP (Federal Employee Program) medical policy, as well as legal and regulatory requirementsMedical decision and support for the behavioral health review for all services currently requiring authorization or review, facilitating appropriate use of all resources, including safe and timely dischargesEngage in telephonic peer-to-peer discussions regarding current members in various levels of care or who may be receiving other specialized services. Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providersTrain BSC utilization and care management staff which may include physicians, psychologists, nurses, social workers, and others as neededPerform clinical reviews to support utilization management and fraud waste and abuse case evaluationsParticipate with the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes for our membersParticipate on projects and committees, as necessaryYour Knowledge and ExperienceMinimum 5 years direct patient behavioral health clinical care experience post residency requiredMedical degree (M.D./D.O.)Completed residency in PsychiatryMaintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states requiredMaintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) requiredPreferred Qualifications:Recent inpatient psychiatric hospital experience (within the past five years)Recent substance use disorders treatment experience (within the past five years)Well-versed with most areas of behavioral health services and conditionsShow ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issuesExperience with CPT coding, medical claims review, hospital billing, and reimbursementDeep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirementsManaged care experience supporting utilization management, case review, and/or quality improvement activities in behavioral healthExperience with ASAM, LOCUS, CALOCUS, and WPATH

Radiology Technologist - Interventional RadiologyWe are seeking a highly skilled Radiology Technologist specializing in Interventional Radiology to join our team. In this role, you will assist in minimally invasive procedures by using advanced imaging technology to guide interventions, ensuring accurate and effective patient care.Key Responsibilities:Prepare patients for interventional radiology procedures by explaining the process and positioning them appropriately.Operate fluoroscopy and other imaging equipment to provide real-time guidance during procedures.Assist physicians in performing diagnostic and therapeutic interventions, such as angiograms, stent placements, or biopsies.Maintain a sterile environment and adhere to infection control protocols during procedures.Monitor patients' vital signs and ensure their safety and comfort throughout the procedure.Document procedures accurately and maintain detailed patient records.Perform routine maintenance and quality checks on imaging equipment to ensure optimal performance.Work Environment:Work in hospitals or specialized interventional radiology suites equipped with advanced imaging technology.Collaborate closely with physicians, nurses, and other healthcare professionals in a fast-paced environment.Be prepared for on-call responsibilities to assist with urgent or emergency procedures.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through specialized training and certifications.A supportive work environment that values innovation and teamwork 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 Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. documentation.Your Work In this role, you will: Coordinates care for Lower Level of Care such as Residential Treatment, Partial Hospitalization Program, Intensive Outpatient Program, other outpatient services, and community programs as appropriate.Research and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying withcontract for each appropriate plan typeProvide Referrals to QualityManagement (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamDesign appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomesInitiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsApplies detailed knowledge of FEP PPO and Blue Shield of California's (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case.Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care.Provides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease).Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member's needs related to behavioral health.Must be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentation.Your Knowledge and Experience 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 fieldBachelor of Science in Nursing or advanced degree preferred.Requires relevant behavioral health experience.Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources.Able to operate PC-based software programs including proficiency in Word and Excel.Strong clinical documentation skills, independent problem identification and resolution skills.Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills.Competent understanding of NCQA and federal regulatory requirements.Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable.Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care.Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making.

Speech-Language Pathologist - Acute Care We are seeking a compassionate Speech-Language Pathologist to provide care in an acute care setting. In this role, you will assess and treat patients with speech, language, voice, and swallowing disorders resulting from acute medical conditions. Key Responsibilities: Evaluate patients' communication and swallowing abilities following acute medical events such as strokes or surgeries.Create individualized treatment plans aimed at improving speech, language, or swallowing functions.Provide therapy sessions tailored to patients' recovery needs in a fast-paced acute care environment.Collaborate with interdisciplinary teams, including physicians and nurses, to ensure comprehensive patient care.Educate patients and families on techniques to support recovery outside of therapy sessions.Maintain accurate records of evaluations, treatment plans, and progress notes for each patient. Work Environment: The role is based in hospitals or acute care facilities where patients require immediate and intensive rehabilitation support.This position involves working closely with critically ill patients in a fast-paced environment requiring quick decision-making skills. Benefits: A competitive salary with opportunities for career advancement within the field of speech-language pathology.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and expand expertise in acute care techniques. Equal Opportunity Employer: Your dedication to improving patient outcomes is valued here. We strive to create an inclusive environment where all employees can thrive professionally while delivering exceptional care to our patients. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role Reporting to the Manager, Care Management- Behavioral Health, the Licensed Clinician, Senior (ABA Case Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs. This role is ideal for professionals with a background and experience in Applied Behavioral Analysis and passion for ensuring access to high quality behavioral health services. The ABA Case Manager will coordinate care and services for families, supporting members and families through their care. The ABA Case Manager will offer support in assessing members’ emotional and psychological well-being and providing resource coordination, crisis intervention, and with any general behavioral or mental health referrals. 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 WorkIn this role, you will:Collaborate with other Case Managers and Utilization Management 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 as well as members seeking and utilizing ABA services.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 ExperienceCurrent unrestricted CA License (LCSW, LMFT, LPCC, Registered Nurse (RN), or PsyD by the Board of Behavioral Health Sciences requiredRequires at least 5 years of prior relevant experience including 3 years of experience in behavioral health or ABA, case management.Advanced degree commensurate with field is preferredBCBA 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 treatmentPrevious health plan or insurance experience preferred.Proficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint

Speech-Language Pathologist - Acute Care We are seeking a compassionate Speech-Language Pathologist to provide care in an acute care setting. In this role, you will assess and treat patients with speech, language, voice, and swallowing disorders resulting from acute medical conditions. Key Responsibilities: Evaluate patients' communication and swallowing abilities following acute medical events such as strokes or surgeries.Create individualized treatment plans aimed at improving speech, language, or swallowing functions.Provide therapy sessions tailored to patients' recovery needs in a fast-paced acute care environment.Collaborate with interdisciplinary teams, including physicians and nurses, to ensure comprehensive patient care.Educate patients and families on techniques to support recovery outside of therapy sessions.Maintain accurate records of evaluations, treatment plans, and progress notes for each patient. Work Environment: The role is based in hospitals or acute care facilities where patients require immediate and intensive rehabilitation support.This position involves working closely with critically ill patients in a fast-paced environment requiring quick decision-making skills. Benefits: A competitive salary with opportunities for career advancement within the field of speech-language pathology.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and expand expertise in acute care techniques. Equal Opportunity Employer: Your dedication to improving patient outcomes is valued here. We strive to create an inclusive environment where all employees can thrive professionally while delivering exceptional care to our patients. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Facility Compliance Review (FCR)team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Seniorwill report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical documents and applying clinical criteria to establish the most appropriate level of care. This role will be focusing primarily on inpatient psych reviews for Residential Treatment and Detox. Also, you will be reviewing hospital itemized bills for a comprehensive line-by-line audit and manual claims processing on exceptions to ensure that appropriate billing practices are followed based on facility specific contract language. These exceptions may include medical necessity, DRG validation, stop loss, trauma, ER, burns, implants, NICU, transplants, hospital acquired conditions/never events and aberrant billing.Your Work In this role, you will: Perform retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEPConducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliancePrepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationand communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirementsDevelop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standardsandidentifypotential quality of care issues, service or treatment delays and intervenes or as clinically appropriateClearly communicates, is collaborative, while working effectively and efficientlyReview itemizations for coding logic using industry standards as well as CMS guidelinesTriages and prioritizes cases to meet required turn-around timesIdentifies potential quality of care issues, service or treatment delays as clinically appropriate.Clinical judgment and detailed knowledge of benefit plans used to complete review decisionsYour Knowledge and Experience Requires a bachelor's degree or equivalent experienceRequires a current California RN LicenseRequires at least 5 years of prior relevant experiencePrevious Inpatient Psych experience preferredRequires strong attention to detail to include ability to analyze claim data analyticsRequires independent motivation, strong work ethic and strong computer navigations skillsPsych claims review experience preferred

Physical Therapist - RehabWe are seeking a dedicated Physical Therapist to join our rehabilitation team. In this role, you will help patients recover from injuries or illnesses by improving their movement, reducing pain, and restoring functionality through personalized therapy programs.Key Responsibilities:Evaluate patients to assess their physical conditions and develop individualized treatment plans.Implement therapeutic exercises, manual therapy techniques, and specialized equipment to aid recovery.Educate patients and caregivers on techniques to improve mobility and prevent future injuries.Collaborate with other healthcare professionals to ensure comprehensive care for patients.Monitor patient progress and adjust treatment plans as necessary to achieve optimal outcomes.Document patient evaluations, treatments, and progress in compliance with healthcare regulations.Work Environment:Work in rehabilitation centers, hospitals, outpatient clinics, or private practices specializing in physical therapy.Engage in a dynamic, hands-on environment that requires physical activity and patient interaction.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 delivery.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Licensed Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members admitted to inpatient facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as neededGather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationProvide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteriaWork with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed ManagerRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and Experience Bachelor of Science or advanced degree preferredCurrent unrestricted CA license (LCSW, LMFT, LPCC, Licensed Psychologist, or Registered Nurse (RN) with Behavioral Health experience)Requires at least five (5) years of prior experience in healthcare related fieldThree (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredStrong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed

Registered Nurse (RN) - Labor and Delivery Join our team as a compassionate Registered Nurse (RN) in Labor and Delivery, where you will provide specialized care to expectant mothers during childbirth and postpartum recovery. This role involves supporting families during critical moments of their lives. Key Responsibilities: Assess and monitor the health status of pregnant women during labor, ensuring timely interventions when necessary.Administer medications and treatments as prescribed by physicians, monitoring patients for any adverse reactions.Support patients during delivery, providing emotional support and guidance throughout the process.Collaborate with healthcare teams to develop individualized care plans for mothers and newborns.Educate patients and families on postpartum care, breastfeeding techniques, and newborn care strategies.Document patient information accurately in medical records, ensuring compliance with regulatory standards. Work Environment: The role is based in hospital labor and delivery units where RNs work closely with expectant mothers and newborns.This position requires strong communication skills and the ability to work effectively in a dynamic, fast-paced environment. Benefits: A competitive salary with opportunities for career advancement within obstetric nursing 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 labor and delivery nursing practices. Equal Opportunity Employer: Your dedication to supporting maternal health is valued here. We strive to create an inclusive environment where all employees can thrive professionally while delivering exceptional care during critical moments of childbirth. *This information is based on general job descriptions. Actual job responsibilities may vary by location.*

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

Registered Nurse (RN) - Operating Room (OR) We are seeking a skilled Registered Nurse (RN) for our Operating Room (OR), where you will assist surgical teams in providing safe and effective patient care during various surgical procedures. Key Responsibilities: Prepare operating rooms by sterilizing instruments, setting up equipment, and ensuring all necessary supplies are available.Assist surgeons during procedures by maintaining sterile fields and handing instruments efficiently.Monitor patient vital signs throughout surgery and respond promptly to any changes or complications.Coordinate with surgical teams to develop individualized patient care plans before, during, and after surgery.Provide patient education regarding surgical procedures, recovery expectations, and postoperative care instructions.Accurately document surgical procedures and patient responses in medical records. Work Environment: This position is based in hospital operating rooms or outpatient surgical centers equipped with advanced surgical technology.The role requires precision, teamwork, and the ability to perform effectively in high-stress environments. Benefits: A competitive salary with opportunities for advancement within perioperative nursing specialties.A comprehensive benefits package including health insurance, retirement plans, and paid time off.Support for continuing education programs to maintain licensure and enhance operating room nursing skills. Equal Opportunity Employer: Your dedication to surgical excellence is valued here. We strive for an inclusive environment where all employees can excel professionally while contributing significantly to patient outcomes during surgery. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

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

Registered Nurse (RN) - Labor and Delivery Join our team as a compassionate Registered Nurse (RN) in Labor and Delivery, where you will provide specialized care to expectant mothers during childbirth and postpartum recovery. This role involves supporting families during critical moments of their lives. Key Responsibilities: Assess and monitor the health status of pregnant women during labor, ensuring timely interventions when necessary.Administer medications and treatments as prescribed by physicians, monitoring patients for any adverse reactions.Support patients during delivery, providing emotional support and guidance throughout the process.Collaborate with healthcare teams to develop individualized care plans for mothers and newborns.Educate patients and families on postpartum care, breastfeeding techniques, and newborn care strategies.Document patient information accurately in medical records, ensuring compliance with regulatory standards. Work Environment: The role is based in hospital labor and delivery units where RNs work closely with expectant mothers and newborns.This position requires strong communication skills and the ability to work effectively in a dynamic, fast-paced environment. Benefits: A competitive salary with opportunities for career advancement within obstetric nursing 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 labor and delivery nursing practices. Equal Opportunity Employer: Your dedication to supporting maternal health is valued here. We strive to create an inclusive environment where all employees can thrive professionally while delivering exceptional care during critical moments of childbirth. *This information is based on general job descriptions. 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