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Other JobsManager, Utilization Management Nurse Management Description: 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 (more...) Company: Blue Shield of California Location: Los Alamitos Posted on: 06/26/2025 Licensed Clinician, Senior- Board Certified Behavior Analyst (BCBA) Description: Your Role The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They (more...) Company: Blue Shield of California Location: Stanton Posted on: 06/26/2025 Behavioral Health Case Management - Nurse, Senior Description: 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 (more...) Company: Blue Shield of California Location: Hawaiian Gardens Posted on: 06/26/2025 Licensed Clinician, Senior Description: Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced (more...) Company: Blue Shield of California Location: Hawaiian Gardens Posted on: 06/26/2025 Licensed Clinician, Senior (ABA Case Manager) Description: 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 (more...) Company: Blue Shield of California Location: Los Alamitos Posted on: 06/26/2025 Manager, Operations (Behavioral Health Utilization Management Intake Team) Description: Your Role The Behavioral Health BH Utilization Management UM Intake team is responsible for timely and accurate processing of treatment authorization requests. The Manager, Operations BH UM Intake (more...) Company: Blue Shield of California Location: Seal Beach Posted on: 06/26/2025 Licensed Clinician, Senior Description: Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced (more...) Company: Blue Shield of California Location: Cypress Posted on: 06/26/2025 FEP Case Management - Nurse, Senior Description: 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 (more...) Company: Blue Shield of California Location: Hawaiian Gardens Posted on: 06/26/2025 Behavioral Health Case Management - Nurse, Senior Description: 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 (more...) Company: Blue Shield of California Location: Seal Beach Posted on: 06/26/2025 Manager, Utilization Management Nurse Management Description: 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 (more...) Company: Blue Shield of California Location: Cypress Posted on: 06/26/2025 |
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