Year Up United is a one-year or less, intensive job training program that provides young adults with in-classroom skill development, access to internships and/or job placement services, and personalized coaching and mentorship. Year Up United participants also receive an educational stipend. The program combines technical and professional training with access to internships and job placement support through our industry-leading talent placement firm YUPRO Placement. If you receive an internship, it may be at Salesforce, Workday, or PayPal among other leading organizations in the California Bay Area (Pleasant Hill, San Francisco, San Jose). Are you eligible You can apply to Year Up United if you are: - A high school graduate or GED recipient - Eligible to work in the U. S. - Available Monday-Friday throughout the duration of the program - Highly motivated to learn technical and professional skills - Have not obtained a Bachelor's degree - You may be required to answer additional screening questions when applying What will you gain Professional business and communication skills, interviewing and networking skills, resume building, ongoing support and guidance to help you launch your career. During the internship phase, Year Up United students earn an educational stipend of $525 per week. In-depth classes include: - Application Development - Customer Success - Project Management - Data Analytics - IT Support - Business Operations - Network Security & Support Get the skills and opportunity you need to launch your professional career. 75% of Year Up United graduates are employed and/or enrolled in postsecondary education within 4 months of graduation. Employed graduates earn an average starting salary of fifty-three thousand dollars per year.

We want you to help us shape the future of shopping experiences and deliver on our purpose of connecting people with the products and experiences that enrich their lives. Joining Advantage Solutions means joining a network of 65,000 teammates serving 4,000+ brands and retail customers across 40+ countries. All the while, being provided the opportunities, support, and enrichment you need to grow your career.In this position, you'll drive sales by engaging customers and bringing brands to life by providing live events and sampling to consumers where they live and shop. Additionally, you will provide support to management as needed.What we offer:Competitive wages; $18.72 per hourGrowth opportunities abound – We promote from withinNo prior experience is required as we provide training and team support to help you succeedAdditional hours may be available upon requestWe offer benefits that can be customized to meet your family’s needs, including medical, dental, vision, life insurance, supplemental voluntary plans, wellness programs, and access to discounts through Associate PerksNow, about you:Are comfortable interacting with customers and management in a friendly, enthusiastic, and outgoing mannerAre 18 years or olderAvailable to work 2-3 shifts per week, including weekendsCan lift up to 50 lbs. on a regular basis and stand for up to 6 hoursAre comfortable preparing, cooking, and cleaning work area and equipmentHave reliable transportation to and from work locationDemonstrate excellent customer service and interpersonal skills with our clients, customers and team membersAre a motivated self-starter with a strong bias for action and resultsWork independently, but also possess successful team building skillsHave the ability to perform job duties with a safety-first mentality in a retail environmentIf this sounds like you, we can’t wait to learn more about you. Apply Now!

Job ID: 268061Location Name: CA-FSC SF Off (0174)Address: 350 Mission St, 20th Floor, San Francisco, CA 94105, United States (US)Job Type: Full TimePosition Type: RegularJob Function: Real Estate/Prop DevRemote Eligible:Hybrid ScheduleCompany Overview:At Sephora we inspire our customers, empower our teams, and help them become the best versions of themselves. We create an environment where people are valued, and differences are celebrated. Every day, our teams across the world bring to life our purpose: to expand the way the world sees beauty by empowering the Extra Ordinary in each of us. We are united by a common goal - to reimagine the future of beauty.The Opportunity:This opportunity centers on leading store design innovation at Sephora, ensuring a high-quality retail experience that balances aesthetics, functionality, and operational requirements. Collaborating with store design teams and cross-functional partners, the Senior Manager is responsible for problem-solving unique site conditions while maintaining a visionary approach to design. The ideal candidate thrives in fast-paced environments, consistently elevating store design quality to uphold Sephora’s brand identity while meeting cost, schedule, and operational goals. Strong leadership skills. Ability to lead, coach, engage, inspire, and develop a team of talented Store Designers. The primary function of this position is a people leader; however, still be expected to handle some project load.Demonstrate a willingness to take on tasks of any size. Support Director with strategic projects. Step in to cover in the Director's absence. Maintain strong relationships with company leaders and possess excellent presentation skills.Provide oversight and serve as the go-to person for Managers of Store Design Responsible for quality control with the team and our 3rd party Architect companies to ensure all drawings meet Sephora design standards and criteria. Coordinate with consultant architects and engineers to incorporate any changes or corrections into the final contract documents.Ensure that drawings are accurate throughout the project lifecycle to ensure that bid information is correct, and construction can begin on schedule.Coordinate closely with Real Estate, Retail Operations, Merchandising and Property Development, Execution, etc. throughout all stages of the design of our stores and provide directions to team to solve issues.Challenge and develop process to streamline projects and gain efficiencies throughout the team. Knowledge and experience necessary to provide planning, interior elevations and storefront design studies based on our current Sephora design standards and specific site conditions, designing for unique conditions as required, and direct and coach the team through design challenges, layouts, and storefront design.Direct and facilitate team efforts to develop project scope of work including review of codes, tenant criteria, merchandise requirements and any other design elements that may need to be incorporated into a project Lead design implementation, CD development, schedules, permitting, and interaction with LL or building officials.Expertly and persuasively communicate Sephora brand Point of view to external partners. Lead input and feedback to team developing store design tools: Template, design guidelines, ideal plans, high level gut checks, feasibility, etc.Contribute industry insights and a fresh perspective to continually improve the delivery of on-brand, beautiful, functional and cost-effective stores.Expertly and independently manage high-profile and complex projects, including special projects such as time studies, template/prototype standards Lead initiatives with cross-functional teams and external partners.Plan and align within Store Design Team and represent the team’s point of view. Lead and develop process evolution as well as new process as necessary, based on best-in-class industry practicesWe'd love to hear from you if you have...7+ years of related experience in Retail Architecture, Retail Design or similar field.8-10 years of leading and/or managing high performing teams.Proficient in AutoCAD, Microsoft Office and Adobe Suite [In-Design, Photoshop, Illustrator].Experienced with one or more computer visualization tools [SketchUp, Adobe, Rhino, 3DS MAX].#LI-MMGThe annual base salary range for this position is $151,810.00 - $169,670.00 The actual base salary offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job. Individuals employed in this position may also be eligible to earn bonuses. Sephora offers a generous benefits package to full-time employees, which includes comprehensive health, dental and vision plans; a superior 401(k) plan, various paid time off programs; employee discount/perks; life insurance; disability insurance; flexible spending accounts; and an employee referral bonus program. This job will be posted for a minimum of 5 days.While at Sephora, you’ll enjoy… The people. You will be surrounded by some of the most talented leaders and teams – people you can be proud to work with. The learning. We invest in training and developing our teams, and you will continue evolving and building your skills through personalized career plans.The culture. As a leading beauty retailer within the LVMH family, our reach is broad, and our impact is global. It is in our DNA to innovate and, at Sephora, all 40,000 passionate team members across 35 markets and 3,000+ stores, are united by a common goal - to reimagine the future of beauty.You can unleash your creativity, because we’ve got disruptive spirit. You can learn and evolve, because we empower you to be your best. You can be yourself, because you are what sets us apart. This, is the future of beauty. Reimagine your future, at Sephora.Sephora is an equal opportunity employer and values diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, ancestry, citizenship, gender, gender identity, sexual orientation, age, marital status, military/veteran status, or disability status. Sephora is committed to working with and providing reasonable accommodation to applicants with physical and mental disabilities.Sephora will consider for employment all qualified applicants with criminal histories in a manner consistent with applicable law.

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.

Job ID: 267700Location Name: CA-FSC SF Off (0174)Address: 350 Mission St, 20th Floor, San Francisco, CA 94105, United States (US)Job Type: Full TimePosition Type: RegularJob Function: FinanceRemote Eligible:Hybrid Schedule, 2 days onsiteCompany Overview:At Sephora we inspire our customers, empower our teams, and help them become the best versions of themselves. We create an environment where people are valued, and differences are celebrated. Every day, our teams across the world bring to life our purpose: to expand the way the world sees beauty by empowering the Extra Ordinary in each of us. We are united by a common goal - to reimagine the future of beauty.The Opportunity:As our Accounting Senior Manager, reporting to the Director of Accounting, you will be working closely with numerous business partners and key stakeholders and be responsible for Retail, FSC and Canada area of the business, manage the P&L and revenue recognition of business. You will also be performing analytical reviews and variance investigations as needed throughout the year, month-end reconciliations, maintaining accounting policies and procedures, and continuing the optimization of accounting and operational processes.Manage FSC, Sephora Canada, Occupancy, Credit Card and Beauty Insider in accordance with US GAAP/IFRS – This includes but is not limited to month end close activities and other day to day activities.Identify and implement key controls and mitigate risks. Monitor, maintain, and improve ongoing processes, accounting policies, and procedures across the business. Identify ways to automate processes and improve efficiency. Lead cross-functional projects to improve the level of internal control and risk management.Collaborate with cross functional teams. Work closely with numerous business partners and key stakeholders (both internally and externally) to implement process improvements, understand variances to budget, and present findings to executive management for decision making.Liaise with external auditors on audit schedules (including OAR flux analysis) and provide requested supporting documentation to ensure a smooth audit.Assist on S4HANA implementationResponsible for ad hoc projectsWe’d love to hear from you if you have …9+ years of related business experience Retail industry preferred but not a mustAdvanced skills with Excel applications (PIVOTs, SUMIFs, VLOOKUPs, macros)Experience with SAPMust demonstrate strong strategic, analytical, interpersonal, organizational, and communication skillsFamiliarity with IFRS accounting principles and financial statementsDriven, able to balance multiple priorities. Good interpersonal skills with the ability to build relationships across all levels of the organizationTech-savvySelf-motivated and resourceful#LI-MMGThe annual base salary range for this position is $151,810.00 - $169,670.00 The actual base salary offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job. Individuals employed in this position may also be eligible to earn bonuses. Sephora offers a generous benefits package to full-time employees, which includes comprehensive health, dental and vision plans; a superior 401(k) plan, various paid time off programs; employee discount/perks; life insurance; disability insurance; flexible spending accounts; and an employee referral bonus program. This job will be posted for a minimum of 5 days.While at Sephora, you’ll enjoy… The people. You will be surrounded by some of the most talented leaders and teams – people you can be proud to work with. The learning. We invest in training and developing our teams, and you will continue evolving and building your skills through personalized career plans.The culture. As a leading beauty retailer within the LVMH family, our reach is broad, and our impact is global. It is in our DNA to innovate and, at Sephora, all 40,000 passionate team members across 35 markets and 3,000+ stores, are united by a common goal - to reimagine the future of beauty.You can unleash your creativity, because we’ve got disruptive spirit. You can learn and evolve, because we empower you to be your best. You can be yourself, because you are what sets us apart. This, is the future of beauty. Reimagine your future, at Sephora.Sephora is an equal opportunity employer and values diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, ancestry, citizenship, gender, gender identity, sexual orientation, age, marital status, military/veteran status, or disability status. Sephora is committed to working with and providing reasonable accommodation to applicants with physical and mental disabilities.Sephora will consider for employment all qualified applicants with criminal histories in a manner consistent with applicable law.

Your Role The Utilization Management Prior Authorization team accurate and timely prior authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The Utilization Management Nurse, Senior will report to the Manager, Utilization and Medical Review. In this role you will be performing first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medi-Cal and Medicare. Successful RN candidate reviews prior auth requests for medical necessity, coding accuracy and medical policy compliance. Clinical judgment and detailed knowledge of benefit plans used to complete review decisions is required.Your Work In this role, you will: Perform prospective 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 BSC Promise Medi-Cal and MedicareEnsuredischarge (DC) planning at levels of care appropriate for the members needs and acuityand determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost-appropriate DC planningPrepare 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 standardsand identifypotential quality of care issues, service or treatment delays and intervenes or as clinically appropriateTriages and prioritizes cases to meet required turn-around times and expedites access to appropriate care for members with urgent needsProvides referrals to Case Management, Disease Management, Appeals and Grievance and Quality Departments, as necessaryOther duties as assignedYour Knowledge and Experience Requires a bachelor's degree or equivalent experienceRequires a current California RN LicenseRequires at least 5 years of prior relevant experienceRequires practical knowledge of job area typically obtained through advanced education combined with experienceExperience working with or for a manage health care plan preferredExperience with Medi-Cal managed care including Medicare preferredEffective time management skills and ability to define and act on priorities efficiently preferredExcellent communication skills both orally and in writing with all levels of BSC Promise staff, members, contracted physicians, and participating provider groups preferred

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

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

Your Role The 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

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

Your Role Reporting to the Manager, Care Management- Behavioral Health, the Behavioral Health Care Management Clinician, Seniorhelps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs. The Behavioral Health Care Manager will offer support in assessing members’ emotional and psychological well-being and providing resource coordination, crisis intervention, substance abuse, and with any behavioral or mental health referrals. The Behavioral Health Care Management Clinician, Senior will be available to physicians and nurse care managers as a consultant for patients with complex psychosocial needs. The position requires an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages.Your Work In this role, you will: Collaborate with case managers and other team members tocomplete member assessments related to social and resource needs tosupportmemberaccess to servicesCollaborate with service coordination staff and act as liaison to ensure a timely and accurate response to member needsCollaborate with providers to support members’ treatment plan and care needsRecognize the client’s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamAssessmembers health behaviors, cultural influences and clients belief/value systemand evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersEfficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness.Maintains an active workload in accordance with National Care Manager performance standards.Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases.Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independentlyAs a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.)Your Knowledge and Experience Current unrestricted CA License (LCSW, LMFT, LPCC, Registered Nurse (RN), or PsyD by the Board of Behavioral Health Sciences requiredAdvanced degree commensurate with field is preferredRequires at least five (5) years of prior relevant experience, including three (3) years of experience in behavioral health.Certified Case Manager preferredExperience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housingConsiderable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatmentProficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint

Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare & Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives.This individual will play a key role as part of the Utilization Management team in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership. The Director, Medicare & Medi-Cal Utilization Management role will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.Your Work In this role, you will: Manages and monitors prior authorization and concurrent review to ensure that the patient is getting the right care in a timely and cost-effective way.Leading development of UM strategy by leveraging the use of data/analytics to inform and technology solutions to streamline operational efficiencies while also building a cost-benefit methodology to rationalize decisions on UM reviews to be performed based upon staffing costs, productivity, and projected medical cost savings.Provides analysis and reports of significant utilization trends, patterns, and resource allocation.Partners with physicians and others to develop improved utilization of effective and appropriate services.Establishing and measuring productivity metrics to support workforce planning methodology and rationalization of services required to perform UM reviews.Reviewing and reporting out on Utilization Review (UR) trending for Medicare and Medi-Cal membership.Ensuring alignment of the authorization strategy with clinical policy, payment integrity, and network development strategies to optimize quality and cost of care.Responsible for managing strategic projects and supporting operations initiatives.Leading operational implementation of transformation changes (organizational management, process implementation, technology adoption).Responsible for operational teams' performance, resource management, continuous improvement, and training.Responsible for operational audit readiness, ensuring adequate processes and internal audit measures in place and maintained quarterly.Ensuring all operational processes are meeting regulatory and accreditation requirements.Fosters a culture of process excellence, BSC leadership principles, and a great place to work environment.Occasional business travel required.Your Knowledge and Experience Requires current CA RN LicenseBachelor’s of Science in Nursing or advanced degree preferredMaster’s degree or equivalent experience preferredMinimum of 10 years of Utilization Management or relevant experience, including 6 years of management experienceMinimum of 5 years of progressive leadership in Utilization Management operationsHealth plan or similar health care organization structure experience requiredSuccessful track record in driving organizational change managementExcellent relationship and consensus-building skills required

Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective, concurrent, retrospective utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Behavioral Health Utilization Management, Consultant (Lead), will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will support the clinicians with daily operations, provide coaching, and serve as the subject matter expert for the BH UM team as they conduct clinical reviews of mental health and substance use authorization requests at various levels of care for medical necessity.Your WorkIn this role, you will:Facilitate communication between leadership, Medical Directors, and non-clinical leads to address line staff questions and issues; escalate matters to management with recommendations or consultation as neededLead onboarding/training of incoming staff, provide proactive and guided support through the onboarding processMaintain and gain knowledge of behavioral health utilization management through team and departmental expansion as neededAct as subject matter expert to review and evaluate the effectiveness of operational workflows to identify problems and develop improvements, modifications, and enhancementsDevelop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staffAssist with audit readiness in collaboration with internal BSC partnersPerform advanced or complicated prior authorization and concurrent utilization reviews and first level determinations for members using non-profit association guidelines ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for oversight and necessity determinationIdentify process and control improvement opportunities and provide recommendations that help improve the effectiveness, efficiency and/or economic value of a control or processProvide guidance, coaching and training on internal behavioral health utilization management processes to other employees across the company as appropriateLead, manage, and execute other special projects and team initiatives as assignedLead team huddles/meetings to support processes and collaboration of team membersSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least seven (7) years of prior experience in healthcare related fieldExperience operating in a lead role or equivalent leadership training is preferredFive (5) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredDeep knowledge of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay clinical against nonprofit association guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed

Your Role The Care Managementteam will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Case Management – Nurse, Senior will report to the Manager of Care Management. In this role you will play a pivotal role in assessing member needs, providing clinical education, as well as care coordinationwith providers, medical groups, and community resources. You will be responsible for managing and coordinating patient care, ensuring that our members receive the highest quality of care and services. Care Managers perform care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.Your Work In this role, you will: Determine appropriateness of referral for CM services, mental health, and social servicesAssess members health behaviors, cultural influences and clients belief/value system. Evaluate all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. Adjust plans or create contingency plans as necessaryIdentify appropriate programs and services that align with member needs and preferencesInitiate timely Individualized Care Plans (ICP) based on Health Risk Assessment (HRA) completion, participation in and documentation of Interdisciplinary meetings (ICT), assisting in transitions of care across all agesProvide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental casesResearch opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipate potential barriers while establishing realistic goals to ensure success for the member, providers, and BSCDetermine realistic goals and objectives and provide appropriate alternatives. Actively soliciting client’s involvementRecognize need for contingency plans throughout the healthcare processProvide education and support to members and their families regarding health conditions, treatment options, and community resourcesFollow up with members as appropriate to ensure they have successfully connected with recommended programs and servicesYour Knowledge and Experience Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hireBachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires 5 years experience in nursing, healthcare, or related field A minimum of 3 years managed care experience in inpatient, outpatient, or managed care environment preferredHealth insurance/managed care experience preferredTransitions of care experience preferredStrong knowledge of healthcare delivery systems, managed care principles, and care coordinationExcellent communication skills

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional Registered Nurse Case Manager will report to the FEP Care Management Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needsYour WorkIn this role, you will:Coordinate care for lower level of care such Skilled Nursing Facility, Home Health, Home Infusion, Acute Rehab, Long-term Acute Care Hospital, Hospice, and other community program as appropriatePerform effective discharge planning and collaborate with member’s support system and health care professionals involved in the continuum of careProvides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease). Outreach to members with HEDIS Care Gaps to assist with closureApply detailed knowledge of FEP PPO and Blue Shield of California's established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each caseResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying withcontract for each appropriate plan typeProvide Referrals to QualityManagement (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamDesign appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomesInitiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsMust be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentationYour Knowledge and ExperienceRequires a current CA RN License.Bachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 5 years of prior experience in nursing, healthcare or related field3+ years managed care experience preferred.Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources preferredBehavioral health, oncology, or OB/NICU/pediatrics experience preferredStrong electronic clinical documentation skills, independent problem identification and resolution skillsKnowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirableCompetent understanding of NCQA and federal regulatory requirementsDemonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-makingDemonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care

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