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

Your Role The 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

Event DetailsJoin us for an Interview and Hiring Day! Registered Nurses welcomed!Location:1680 E. 120th Street, Los Angeles, California 90059Date: Tuesday, June 24thTime: 9:00 am to 3:00 pmDirections/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car.Click RSVPNow to get startedThis event is for experienced Registered Nurses*Nurse Residents please send your resume for consideration for our next cohort opening September 2025, please review our website for dates. Here's why it's great to be a nurse at MLKCHMLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

Your Role Reporting to the Chief Medical Officer, the Senior Medical Director, Clinical Strategy will define the vision and priorities for Blue Shield of California’s strategy to deliver best in class clinical outcomes for our members while working to ensure that health care is affordable. In this role you will be accountable for working in partnership with other leaders to deliver best in class clinical programs and align our value-based care models to meet our clinical strategy objectives. Your WorkIn this role, you will:Develop a clinical strategy framework and guiding principles, grounded in data on population health outcomes and cost, to deliver Best in Class clinical outcomes for Blue Shield of California membersDefine the organization’s overall clinical strategy, as relates to priorities, partnerships, and key measures of success to improve member experience, population health and affordability, inclusive of primary care and specialty careCo-chair the Clinical Program Review and Governance Committee with the Chief Medical Officer to ensure that all clinical programs are delivering expected clinical and cost of care outcomes for our membersWork with teams performing vendor management to ensure that contracts include appropriate metrics to ensure programs are meeting operational targets to achieve clinical objectivesCollaborate with the Health Economics team to develop the methodology to evaluate the effectiveness and lead a process to ensure robust evaluation of all clinical programsCollaborate with business leaders to ensure that the clinical strategy and clinical programs are meeting business, client, and member needsCreate an environment of accountability and continuous quality improvement to ensure that all clinical programs continue to meet and exceed objectives necessary to deliver best in class clinical outcomes for Blue Shield of California membersCommunicate internally and externally the vision and strategy to transform healthcare to deliver Best in Class clinical outcomes for Blue Shield of California membersYour Knowledge and ExperienceMinimum of 2 years of previous medical leadership experienceMinimum of 5 years of direct patient care experience post residencyMinimum 4 years experience in observational study design and execution and/or clinical program evaluationMedical degree (M.D./D.O.)Maintain active, unrestricted California State Medical License required; Maintain active, unrestricted Medical License in all additional assigned states requiredMaintain Board Certification in one of ABMS, ABOS, or AOA recognized specialty requiredOutstanding verbal and written communication skillsAbility to lead through influence in a matrixed organizationMasters or PhD in Health Services Research, Epidemiology, Biostatistics or similar field preferredExperience in a health plan or managed care organization is preferred

Your Role The Behavioral Health Teamis responsible the coordination of care and assistance in finding providers for members in need. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor, Operations -Behavioral Health . In this role you will be for supporting clinical staff day-to-day operations.Your Work In this role, you will: Work in a production-based environment with defined production and quality metrics.Process Faxed /Web Portal /Phoned in Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.The CSC will oversee designated queues and workstreams, with standardized reports to detect and address member needs.Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider networksData entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.Serves as an initial point of contact for providers and/or members in the behavioral health management process by telephone or correspondence.Assists with system letters, requests for information and data entry.Provides administrative/clerical support to Behavioral Health management.Your Knowledge and Experience Requires a high school diploma or equivalentRequires at least 3 years of prior relevant experienceDesired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.

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

Your Role The Medical Director, National Accounts position is dedicated to supporting the promotion of growth and increased market share of the National Accounts and the Administrative Services Only (ASO) business. This includes strategic clinical and healthcare cost management guidance for the existing Blue Shield of CA book of business. This position will report directly to the VP, CMO, Commercial Markets. This position provides clinical direction to the sales team and sales processes and interacts directly with employers and consultants. This role will be at the center of driving strategy for how to reduce cost of care, while providing client advisory services, increasing engagement, and improving the quality of care & population health for our employers’ membership.Your Work In this role, you will: Lead client and producer facing activities including finalist presentations and account services meetings, broker and consultant meetings, meetings with Mercer, WTW, Aon, etc. Actively participate in and guide the preparations and the actual client meetings. Other activities include interpreting clinical data for employers at regular or pre-determined intervals, reviewing cost/spending trends, making recommendations on improving member engagement and population health. You will work diligently both internally and externally to develop, refine, and expertly communicate the BSC Clinical Value Proposition.Work collaboratively with other Healthcare Solutions and BSC staff to quickly resolve client service issues, with particular emphasis on clinical issues. Be available to talk with key account members about their issues and the solutions.Act as a strategic thought-partner for key clients (e.g. UC, Stanford, CalPERS) who want best-in-class medical, health and wellness programs.Responsible for the planning, development, and leading the delivery of Healthcare Solutions related materials to clients, producers and business associations that describe and explain the operational details and value of Healthcare Solutions capabilities, services and programs. Includes working with the Health Data Reporting teams to analyze data trends and develop external customer reports.Support other ASO Line of Business activities such as: business planning, business development, and designing and implementing innovations to address market needs.Your Knowledge and Experience Medical Degree (M.D./D.O.)Completed residency preferably in adult based primary care specialty (e.g. internal medicine, family practice)Active, unrestricted California State Medical LicenseMinimum 10 years managed care experience requiredAt least five years clinical experience requiredExperience with California managed care marketplace is requiredPrevious experience in national, complex account management support is requiredExperience supporting Administrative Services Only (ASO) lines of business is preferredPrevious experience in a similar sales role preferredPrior experience as a people manager preferredExcellent verbal and written communication skills, including ability to speak comfortably and extemporaneously to diverse audiencesAbility to explain program, clinical, operational, and quantitative information in a business-like, clear, coherent, and comprehensible wayStrong quantitative and analytic skills working with claims, operational, and clinical data and reportsExcellent interpersonal communication skills, including active listening, self-management and awareness, emotional intelligence, and ability to flex interpersonal style situationalDemonstrated ability to model a collaborative approach with internal and external stakeholdersStrong negotiation and creative problem-solving skillsStrong skills with Microsoft Office Suite, including PowerPoint, Excel, Word and Outlook

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

Your Role The Performance Marketing team is responsible for executing and optimizing digital communications, measuring campaign activities, and generating insights that support year-over-year improvements in the efficiency of our marketing activities. We strive to move at the speed of retail, and pride ourselves on the results we get for our members and business partners . The Marketing Operations Specialist, Principal - Insights & Reporting will report to the Sr. Manager, Performance Marketing . In this role you will be accountable for partnering with the other marketing team members to architect a data capture and measurement system, within an omni-channel environment that effectively deciphers, visualizes, and communicates actionable insights . Your Work In this role, you will: Act as an exceptional strategic marketer who can bring analytical thought leadership, challenge business objectives, and provide clear direction to agencies and internal teams who create marketing strategies, architect omnichannel campaigns, implement analytics systems, and build reporting dashboards Collaborate with cross-functional teams and agency partners to develop a sustainable analytics and insights engine within a highly segmented, omni-channel environment Coordinate efforts across internal teams and external agencies to define business goals, and set performance metrics and KPIs across a full-funnel consumer journeyOversee campaign performance. Includes the collection, aggregation, and visualization of performance data, while consulting with business partners on insights and optimization opportunities Utilize statistical techniques to analyze and interpret trends by channels, geographies, segments, and more to create a narrative behind the data; Share actionable insights with senior marketing leadership and channel owners Drive large, complex project initiatives of strategic importance to the organization, involving large cross-functional teams Ensure analytical rigor is continuously applied to optimize the consumer experienceDevelop and engage in segmentation and positioning activities to support overall program strategyPartner with leadership to monitor industry trends and evaluate market and competitive opportunities May direct the work of other individual contributors and/or act as a cross-functional team lead Your Knowledge and Experience Requires a bachelor's degree or equivalent experience and/or equivalent combination of education and experienceRequires at least 10 years of prior relevant experience including marketing analytics, business intelligence, or similar areas Requires ability to perform quantitative and qualitative market analyses to identify key market trends and interpret findings to create insights from that data Requires expertise in analyzing and interpreting marketing data to draw conclusions Requires experience working within an omni-channel environment Highly organized, detail-orientated, and self-motivated Superb executive communication skills: written and verbal. Ability to adapt communication style to audience Strong Influence Skills: Ability to influence others to adapt strategic plan Advanced knowledge of Adobe Consumer Journey Analytics strongly preferred Advanced knowledge in Tableau strongly preferredAdvanced knowledge of visualizing data MS Excel and PowerPoint strongly preferred#LI-AD3